
Book. -F*/£ 



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COPYRIGHT DEPOSm 



Elements 

of 

Active - Principle 
Therapeutics 

By 



J. M. FRENCH, M. D. 
I 




CHICAGO 

THE ABBOTT PRESS 

1916 



n ft* 



Copyright 

The Abbott Pres* 

1916 




&CtA43727i 



To Dr. Robert Gray 

By birth a Southern gentleman, by edu- 
cation a Parisian scholar, in early life a 
surgeon in the Confederate army, and now 
for many years a successful physician in 
tropical Mexico; whose successful applica- 
tion and enthusiastic advocacy of active- 
principle therapy has won him favorable 
recognition in many lands; to whom the 
writer is indebted for many personal and 
professional favors, and for whom, though 
never having seen him, he yet entertains 
a warm personal regard, this little volume 
is affectionately inscribed. 



INDEX 

PAGE 

The Development of Active-Principle Therapeutics . . 1 

The Fundamental Laws of Active-Principle Thera- 
peutics 15 

The Minor Peculiarities of Active-Principle Thera- 
peutics 33 

The Materia Medica of Active-Principle Thera- 
peutics 49 

The Active-Principle Treatment of Pneumonia 65 

The Treatment of Typhoid Fever 79 

The Treatment of Acute Infections 97 

The Management of Chronic Maladies 113 



PREFACE 

Nothing has ever been written — or at least nothing has 
ever come to my notice — which has seemed to me equal, 
as an introduction to the use of the active principles ac- 
cording to the method of the immortal Burggreave, to 
the first edition of Dr. Shaller's "Guide to Alkaloidal 
(Dosimetric) Medication." Especially did this work 
meet the wants of the times in which it was written, 
when the method described was a new one, and the 
physicians into whose hands the work might fall, needed 
to be enticed into the use of the new forms and ways 
by the skill of a master not only of medicine but of 
language. 

But now that the dosimetric method has been modi- 
fied, naturalized, and re-named, as a result of its intro- 
duction into and popularization in America by Dr. 
Abbott and his ever-increasing band of fellow workers, 
it seems desirable to have a re-statement of the old 
truths in the new forms. It is this which is attempted in 
the little work which is here presented — which is, in- 
deed, but a primer of its subject, and aims only to state 
the fundamentals of active-principle therapy as clearly, 
as definitely, and as briefly, as lies in the power of its 
author. 

John Marshall French, M. D. 

Milford, iMass., March, 1916. 



Elements of 
Active-Principle Therapeutics 

CHAPTER I 

The Development of Active-Principle Therapeutics 

\\T HEN I was a student in Dartmouth Medical 
^ School, one of the professors told us a little 
story one afternoon, to while away an otherwise dull 
hour, which made so deep an impression on my mind 
that I have never forgotten it. 

It was the story of a young man who had been suffer- 
ing for a long time from some obscure disease and was 
steadily growing worse, while the attending physician 
gave little hope of his recovery. Finally, as a last re- 
sort, and at the request of the patient's father, a con- 
sultation was held, six of the ablest physicians in the 
vicinity being summoned to examine the sick man and 
consider what could be done for him. The doctors met, 
and each one made a thorough study of the patient and 
his symptoms, after which they retired to a private room 
for consultation. Meanwhile the anxious father, deter- 
mined to know the opinion of the consultants at first 
hand, and not as it might be doctored up and given out 
in the interests of the attending physician, had secreted 
himself in a closet in the room where the physicians 
were to meet and listened intently to the discussion 
which took place. 

One by one, beginning with the eldest and coming 
down to the youngest, as is duly provided by the code of 
ethics, these wise and scientific men delivered themselves 
each of his own opinion as to the diagnosis and pathology 
of this baffling case and each offered the best explana- 
tion he could present of the obscure and unusual symp- 
toms from which the patient was suffering. 



2 ACTIVE-PRINCIPLE THERAPEUTICS 

The Thing of Most Interest— The Curo. 

Finally, when all the older men had spoken, it came the 
turn of the youngest and last of the six. ' ' Gentlemen, ' ' 
he began, "we have spent all our time thus far in con- 
sidering the nature of the disease from which this man is 
suffering. The thing which interests me most is, what 
will cure him." 

In the closet the listening father in his heart ap- 
plauded and quickly registered the vow, "This is the 
doctor that shall treat my son." 

So it is that men seek a physician to be cured of their 
diseases or be relieved of their pains; and he is a poor 
doctor, from their standpoint at least, who can not grant 
them the one boon or the other. To the physician the 
diagnosis is important and the pathology is essential; 
but to the poor victim and his friends the cure is every- 
thing. To the men and women who- employ us, who pay 
our bills and furnish us a living, we are simply doctors, 
and not scientific men ; curers, and not preventers of dis- 
ease. From their point of view, the doctor who, when 
called to attend a sick man, tells him at the outset that 
his disease is self -limited and must run its course, that 
it can not be aborted, cut short or modified in any way 
by medical treatment, is not worthy of the name of 
physician and has no excuse for pretending to treat the 
sick. 

And, frankly, when you come to think about it, how 
would you like that kind of a doctor to treat you when 
you are sick ? When that time comes, you will be likely 
to feel that the real business of a doctor is to cure you ; 
and if he does not know how, then his business is to find 
out how. You will be apt to realize then that the diag- 
nosis and pathology of disease are merely preliminaries 
to the all-important business of treating, and, if possi- 
ble, curing the sick person. 



ACTIVE-PRINCIPLE THERAPEUTICS 3 

My good friend, your dean, suggested to me some 
months ago that he would like to have me give a few 
talks on some practical subject to the students of this 
college. When in response I proposed to talk to you 
about active-principle medication — than which I know 
of no more practical subject in medicine — he expressed 
a fear lest I might find it difficult to interest you in such 
a subject. 

I confess that I was somewhat surprised at this reply ; 
for I am unable to understand how it can be possible 
that you, who have undertaken to fit yourselves to prac- 
tice medicine, could fail to take a lively interest in the 
most important part of the curriculum, the treatment 
of disease. Surely, this can not be true — it is unthink- 
able. There are only two explanations which occur to 
me, .and the first is that my friend himself is not con- 
vinced of the practicability and superiority of the meth- 
ods which I shall advocate ; but from my long acquaint- 
ance with him I can not believe that such is the case. 
There remains only the alternative that the Doctor fears 
I may not be able to put the matter in such a way as to 
make it clear, and plain, and attractive to you. Well, 
that is up to me — and to you, to decide. 

Active-Principle Medication Not a "New System" 

Active-principle medication (which is also known as 
dosimetry, alkalometry, alkaloidal medication, active- 
principle therapeutics, and by various other names) is 
not, and does not claim to be a new system of medicine, 
but only a new method of employing drugs; and I be- 
lieve, and shall endeavor to convince you, that it is at 
once the most potent, the safest, the most convenient, 
and in every way the most satisfactory — both to patient 
and physician — of all known ways of using drugs for the 
cure of the sick. 



4 ACTIVE-PRINCIPLE THERAPEUTICS 

It is. in no sense a school or a sect, and must not be so 
understood. 

Active-principle medication stands for therapeutic 
optimism, as opposed to the prevalent therapeutic nihil- 
ism of the day. The active-principle physician is a man 
who believes he can do things. He believes that remedial 
agents, when properly administered, positively do exert 
a favorable influence upon the course and termination 
of disease-processes. And not only does he hold this as 
an abstract truth, but he confidently affirms, as to a 
large class of cases, that he has found the drugs that 
will do the work, and has learned how and when to ad- 
minister them so as to obtain the desired result; while, 
as to the remainder, he is searching diligently for the 
means required, and confidently looks, day by day, for 
their discovery. 

There has been great progress in all departments of 
medicine during the last quarter of a. century, and not 
the least in the department of therapeutics. The change 
has included the forms of the medicines used, the meth- 
ods in which they are administered, and the indications 
for which they are employed. 

When I began to visit patients with my preceptor, he 
used to carry a big black trunk filled with nauseous pills 
and powders and liquid abominations. Today I can 
carry more kinds of drugs (and do vastly better work 
for my patients) in a pocket-case of 2-dram vials filled 
with clean, neat-looking granules or tablets. 

My preceptor gave saltpeter and "spirits of niter" 
to lower the temperature in typhoid fever, with pow- 
dered opium to lock up the secretions and relieve the 
pain, and brandy or whisky to start up the flagging 
pulse. I, today, go about it in a very different way. 

He did not care to begin the treatment until the symp- 
toms were well marked and the diagnosis evident. I 
want to see my patient at the earliest possible moment, 



ACTIVE-PRINCIPLE THERAPEUTICS 5 

before I or anybody else can tell what is the nature of 
the fever from which he is suffering. 

His endeavor was to conduct the sick man safely 
through the various phases of the dreaded disease, and 
save his life by heroic measures, at the last, if necessary. 
My aim is to save him serious illness, if possible — and, if 
I can do it without permitting the development of symp- 
toms enough to warrant a definite diagnosis, I am so 
much the better pleased ; and so is the patient. 

A Mighty Progress: The Active-Principle Materia Medica 

Now, I do not mean to intimate that all the progress 
in therapeutics has been in the direction of the active 
principles, for that would be absurd. We have the syn- 
thetics, and the animal extracts, and the serums and 
antitoxins, electrotherapeutics, spondylotherapy, and 
other forms of physical therapy and many things equally 
important; and no one treats diseases as they were 
treated forty years ago. But it is my desire to interest 
you in the use of the active principles after the manner 
of Burggraeve and Abbott, and their followers. 

It was one of Boston's honored pharmacists, Mr. F. 
A. Davidson, president of the Theodore Metcalf Com- 
pany, who, on one occasion, said in the local medical 
society, of which I am a member, that the alkaloidal 
granule represented the highest development of the art 
of the pharmacist. And it was another of the most 
prominent pharmacists of the country, Mr. J. K. Lilly, 
of Indianapolis, president of the firm of Eli Lilly & Co., 
who in, a recent article in TJie Pharmaceutical Era upon 
the development of American pharmacy, after describ- 
ing some of the improvements which have already been 
made and still remain to be made in pharmacy and 
therapeutics, adds: 

"We further predict that even more radical changes 
will occur in the next quarter century ; that all the 



6 ACTIVE-PRINCIPLE THERAPEUTICS 

progress of the one just closing will be as child's play 
compared to that which will be experienced between 
1912 and 1937. Crude drugs will gradually disappear, 
to be replaced by active principles, synthetic products, 
and biologies. The practice of injecting intramuscu- 
larly and intravenously will increase. Punishing the 
stomach with large, frequent, and nauseous doses is 
bound to give way where possible to more refined and 
direct methods. Medicine will become less and less em- 
pirical, and more and more rigid demands will be made 
upon the manufacturer. We are profoundly convinced 
that these demands will be fully met. ' ' 

The Development of the New System 

Let me now sketch for you in brief outline the de- 
velopment of this new system, which can be traced in 
three successive steps, the first of which made the sys- 
tem possible, the second made it an accomplished fact, 
while the third made it an indispensable necessity to 
every progressive physician. 

The initial step consisted in the discovery of the alka- 
loids and other active principles of medicinal plants, 
thereby providing the necessary material. 

The first of the alkaloids to be brought to the knowl- 
edge of the medical profession was morphine, which was 
isolated and described by the apothecary Sertuerner, in 
the year 1816. Within the next sixteen years, strych- 
nine, brucine, quinine, eiiichoiiiiie, narcotine, codeine, 
vera.trine, coniine (or cicutine), atropine, nicotine, acon- 
itine, and hyoscyamine were discovered by different 
chemists, so that by the end of the first third of the nine- 
teenth century no less than thirteen alkaloids were 
known and prescribed by physicians. Since then numer- 
ous additions have been made to the list of active prin- 
ciples, which includes not only the alkaloids proper, but 
many rosins and gluoosidos, besides some misccllaneons 



ACTIVE-PRINCIPLE THERAPEUTICS 7 

principles, and concentrations sufficiently potent to al- 
low them to be classed either as active principles or with 
them. 

Many of the latter class of remedies were up to a re- 
cent date manufactured by B. Keith & Co:, of New 
York, and by Lloyd Brothers, of Cincinnati. They were 
for a time enthusiastically advocated and largely em- 
ployed by the eclectics ; but most of these so-called resin- 
oids were later discarded by them, as a, school, in favor 
of what are called the "specific medicines" that were 
first introduced by Dr. Scudder, and afterward man- 
ufactured by the Lloyds and by Merrell. At present, 
along with these active vegetable derivatives — not, in- 
deed, similar to them in derivation, but similar in use — 
are included a considerable number of the more potent 
chemical synthetic and inorganic substances, which are 
largely used by the active-principle therapists. 

The Principle of Dosimetry: Minute, Frequent Dosage 

The second step in the development of active-principle 
therapeutics consisted in the establishment of certain 
general principles governing the use of the active prin- 
ciples as to methods, indications, and dosage, for the 
purpose of accomplishing certain definite therapeutic re- 
sults. This revolutionary step was brought about by the 
master-mind of Burggraeve, of Belgium, who conceived 
and elaborated the method which he named dosimetry. 

Dr. Burggraeve had seen the defects of the old sys- 
tems ,of therapeutics, in which the natural drugs were 
the sole medicinal resources of the doctor. These were 
administered mostly in their crude form or in the shape 
of voluminous mixtures, and were inconvenient to carry, 
unpleasant to take, very uncertain as to action, and de- 
cidedly unsatisfactory in their results. From such a 
combination eventually, and inevitably, there came into 



8 ACTIVE-PRINCIPLE THERAPEUTICS 

being, on the one hand bald therapeutic nihilism and, on 
the other hand, blind faith in the various forms of sug- 
gestion. 

Adolph Burggraeve was born in Ghent, Belgium, in 
the year 1806. He died in 1902, after nearly a century 
of life spent in his chosen profession, the later years of 
his active life having been devoted to the development of 
the system of therapeutics, which is his masterpiece. He 
became professor of anatomy, and later of clinical sur- 
gery, in the University of Ghent ; also he was a member 
of the Royal Academy of Brussels. It was at the latter 
institution that he conceived and elaborated the system 
of dosimetric medication — an enduring foundation upon 
which his fame will ever rest. 

The Principles of Dosimetry, According to Burggraeve 

As stated by Burggraeve, dosimetric medicine rests 
essentially upon its power to jugidate those fevers in 
ivMcJi all acute maladies have their commencement. Its 
great end is to prevent anatomo-pathologic (this is Burg- 
graeve 's own wording) lesions, for these once established 
are above the resources of art. 

The study of morbid causes he declares to be indis- 
pensable, since without it medicine is little more than 
empirical. The dosimetric medicaments are simple,, 
never composite or amalgamated. The "dominant" 
treatment, as it is known in dosimetric practice, consists 
in attacking the morbid cause. The "variant" treat- 
ment is applied to those symptoms through which the 
diseased organism makes known its sufferings. 

To acute maladies, dosimetry opposes a sharp and ac- 
tive treatment, while chronic maladies are combated by 
more deliberate methods of treatment, That is to say, in 
acute maladies the treatment must proceed as rapidly 
as the disease, in order to prevent organic disturbances; 



ACTIVE-PRINCIPLE THERAPEUTICS 9 

but in chronic maladies the treatment should proceed 
slowly, in proportion to the lengthened duration of the 
disease. 

The medicaments most commonly administered are the 
single, proximate principles, such as the alkaloids, which 
are given in divided doses, usually in the form of soluble 
granules. 

These are, in substance, the words of Burggraeve him- 
self and may be taken to represent accurately the spirit 
of dosimetric medicine as understood by its founder. It 
is worthy of note that he gives the place of first impor- 
tance to the object to be accomplished, and the second 
only to the medicaments to be prescribed. 

Although Burggraeve was able to show remarkable re- 
sults in the treatment of disease by his new method, yet 
he did not succeed in securing its adoption to any con- 
siderable extent, until after he had interested Chantaud, 
a noted pharmacist of Paris, in his undertaking, and 
formed an alliance with him, according to which the lat- 
ter thereafter devoted his great skill to the manufacture, 
of the highest grade of alkaloidal granules that had ever 
been produced, and in this way became the practical co- 
worker with Burggraeve in building up his new therapy. 
From this time on the dosimetric treatment of Burg- 
graeve spread rapidly, and especially did it begin to 
flourish in Belgium, France, Spain, Portugal, Italy, Hol- 
land, and Denmark. 

The next step in the evolution of modern active-prin- 
ciple medication consisted in certain modifications of the 
original system of dosimetry, and the broadening of its 
scope and methods, attendant upon its introduction into 
America. 

One of the first men in this country to become in- 
terested in the new system was Dr. W. T. Thackeray, 
who purchased an outfit for the manufacture of alka- 
loidal granules from Dr. Chartier, of Paris, and en- 



10 ACTIVE-PRINCIPLE THERAPEUTICS 

deavored to persuade Messrs. Parke, Davis & Co., in 
whose employ he was, to engage in the business of man- 
ufacturing them. The firm,, however, declined to under- 
take it, considering the commercial difficulties in their 
introduction too great. Thereupon Dr. Thackeray him- 
self formed a company for the manufacture of the gran- 
ules, and started and issued a few numbers of a journal, 
which he called The Alkaloidal Clinic, devoted to the 
advocacy of dosimetric medication. However, he did 
not succeed in making a success of either branch of the 
undertaking, and the enterprise soon ended in failure. 

Abbott and Waugh Enter the Lists 

Not long after this, Dr. Wallace C. Abbott, then a 
young doctor from Vermont, who had been graduated 
from the Medical Department of the University of Mich- 
igan, and had located in the suburb of Ravenswood, of 
Chicago, who happened to have been for some time in- 
terested in the teachings of Burggraeve, began in a small 
way the manufacture of alkaloidal granules, in order to 
supply himself and also the friends whom he had inter- 
ested in this subject; and, in 1894, he began the issue of 
a new Alkaloidal Clinic. 

Dr. Abbott was a man of unbounded energy and de- 
termination, and his enthusiasm proved contagious and 
caused the alkaloidal idea to spread rapidly. I myself 
am one of those whom he interested early; and in my 
library I have preserved not only the first issue of Tlic 
Alkaloidal Clinic, but nearly every number that has fol- 
lowed. From that time onward, his has been the central 
figure in the propaganda for active-principle therapy in 
America, and his aphorism, "The smallest possible 
quantity of the best obtainable means to produce a de- 
sired therapeutic result," has been the slogan for rally- 
ing its forces to the battle. 



ACTIVE-PRINCIPLE THERAPEUTICS 11 

Soon Dr. Abbott associated with himself Dr. William 
F. Waugh, an accomplished scholar, a successful physi- 
cian and medical teacher, and a versatile and forceful 
writer, and who has since then shared in the work of 
editing The Alkaloidal Clinic — the name of which later 
was changed to The American Journal of Clinical Medi- 
cine as the scope of the work was broadened. These 
two active and brilliant men were for a time also as- 
sociated in the manufacture of all the medicaments em- 
ployed in alkaloidal therapy, so called; a designation, 
however, which in the course of years grew much 
broader than the term would indicate, until it has finally 
come to include many remedies besides the alkaloids. 
The present status of the method may best be stated in 
the language of Dr. Abbott himself, who very properly 
may be called the father of American active-principle 
medication, as Burggraeve was the originator of the 
earlier form of dosimetry. These are the leading prin- 
ciples governing the newer, more positive, more definite 
way of combating disease: 

The Principles Governing Active-Principle Therapeutics 

"1. The administration of small doses of the most 
active and potent known remedies at short intervals, 
until either remedial effect or signs of drug-sufficiency, i. 
e., the full physiological effect, are secured. 

"2. The administration of such doses in the form of 
soluble granules or tablets each of which contains a defi- 
nite amount of the drug. 

"3.' The additional use of such solvents, eliminants, 
vital incitants, and local and systemic antiseptics as have 
proven of remedial value. 

"4. The use of any and all remedial agents in the 
most concentrated form available that will produce defi- 
nite results in recognized conditions. 



12 ACTIVE-PRINCIPLE THERAPEUTICS 

"5. The avoidance of promiscuous combinations, 
problematical remedies, crude drugs, and nauseous, 
changeable alcoholic tinctures and fluid extracts when 
the active (remedial) principle of the drug can be ob- 
tained in its purity and given in effective, well-estab- 
lished doses." 

Many other honored names have been associated with 
those of Abbott and Waugh in the building of active- 
principle therapy in America — a structure which is still 
in the process of making. Among them are those of 
John M. Shaller, the author of the best manual of alka- 
loidal medication for beginners; E. M. Epstein, who may 
be termed the scholar of the method ; Coleman, the per- 
sistent advocate of systemic antisepsis in the prevention 
and treatment of the contagious fevers; Alfred S. Bur- 
dick, the present managing editor of Clinical Medicine ; 
and George F. Butler. Many more names might be 
mentioned, in fact one hardly knows where to stop. 

As to the present status of active-principle medication, 
it can be said that many thousand physicians are using 
the methods and medicaments referred to in their daily 
practice to a greater or less degree, and their number is 
each year increasing. Enthusiasm and optimism are the 
characteristics of these men as a class. They claim that 
they are better physicians because of the teachings of 
Burggraeve and his successors; that the principles and 
methods of dosimetry have enabled them to meet disease 
with greater confidence, and overcome its manifestations 
with greater certainty, than the}' were able to do with 
the old galenic methods. 

One of my own most intimate friends, the physician 
through whom I got my first introduction to this newer 
and better method, assures me that under the uncertain- 
ties of the old system of medication he had lost all en- 
thusiasm and nearly all interest in the practice of medi- 
cine, and was seriously contemplating changing his occu- 



ACTIVE-PRINCIPLE THERAPEUTICS 13 

pation, when, thanks to Doctor Abbott and The Alka- 
loidal Clinic, he was ushered into a new world in his 
profession, given a new confidence in his ability to help 
the suffering, and filled with a new enthusiasm in the 
practice of medicine. And I can confidently affirm, 
from my own knowledge of this physician, that this op- 
timism has never left him, but that he is today a broad- 
minded, well-balanced, optimistic, and successful prac- 
titioner, a man who believes in himself and in his power 
to relieve suffering and to prevent and cure disease — 
and these are the things which every doctor needs to be- 
lieve and do. 



CHAPTER II 

The Fundamental Laws of Active-Principle Thera- 
peutics 

LAST week I described to you the origin and growth 
of active-principle medication in Europe and 
America. Today I desire to call your attention to the 
fundamental laws, general principles, or elementary 
teachings, upon which this method of therapeutics is 
based. 

According to my conception, these are three in num- 
ber, and these three embrace all the things which are 
strictly essential to the method, although many other and 
less important peculiarities and practices have grown up 
around them, and of these I shall speak in my next 
lecture. 

The Use of the Active Principles. 

The first law teaches the use of the active principles 
in the treatment of disease. 

The term "active principles," as here employed, is 
interpreted to include not only the alkaloids proper, but 
also many glucosides, resins, camphors, neutral prin- 
ciples, resinoids (so called), and concentrations of vege- 
table drugs, together with such definite chemical com- 
pounds as are sufficiently potent to produce positive re- 
sults in minute doses, and of sufficient medicinal virtue 
to render them desirable additions to the physician's 
armamentarium. 

This law has usually been considered not only as the 
first, but the most important of the three. The follow- 
ers of active-principle medication are ever ready to put 
it to the front, and defend it as the cardinal principle of 
their faith and practice. If you ask them for their rea- 
sons, they will point you to the acknowledged facts that 



16 ACTIVE-PRINCIPLE THERAPEUTICS 

quinine is more active than Peruvian bark, atropine more 
positive in its effects than belladonna, morphine more 
definite and certain in its results than opium, pilocarpine 
more uniform in its effects than jaborandi, strychnine 
more efficient than nux vomica, and, in general, every 
active principle more potent, more uniform, and more 
reliable than the crude drug from which it is derived, 
or its galenic preparation. 

This being the case, he holds that it is manifestly bet- 
ter to employ these active principles and reject the 
bulky residue, the inert matter, the unknown and unre- 
liable substances whose effects cannot be predicted with 
any degree of certainty. For why should any part of a 
plant or of an animal or mineral substance which is not 
active be used in medicine ? Instead of choosing his rem- 
edies for their bulk, and possibly for their disagreeable 
qualities, as was apparently in some instances the cus- 
tom in olden times, he seeks for "the smallest possible 
quantity of the best obtainable means to secure a desired 
therapeutic result/ ' 

Arguments in Favor of Active Principles 

If we analyze the arguments in favor of the active 
principles, we shall find that they can be separated into 
three classes. 

First, because, as compared with the crude drugs and 
their galenic preparations, they are condensed in form, 
minute in dose, and positive in results; containing only 
the active remedial principle of the drugs which they 
represent, and rejecting the inert material. 

Secondly, because they are uniform in composition, 
containing, as a rule, but a single therapeutic principle, 
and therefore always to be be relied upon as producing 
the same remedial effect; whereas the crude drug may 
contain several unlike and even opposite principles, and 



FUNDAMENTAL LAWS 17 

these may occur in different proportions in different 
specimens of the drug, so that one sample of a galenic 
may be much stronger than another which was prepared 
from the same formula, and different samples similarly 
labeled may produce entirely different and even con- 
flicting results. Recent analyses of standard tinctures on 
sale in the different drug stores of the same cities have 
shown a wide variation in strength, although all were 
supposed to contain the same percentage of the drug. 

The drug-strength of a plant is affected by the char- 
acter of the soil, the amount of sunshine, the tempera- 
ture, and many other conditions of environment. And 
these may change, not only the total amount of active 
principles in a plant, but the relative proportions of the 
different principles in the same plant. 

A good illustration of this fact is found in jaborandi, 
which contains two active principles, pilocarpine and 
jaborine, the one of which is the most potent of all our 
diaphoretics, while the other is the exact opposite, its 
effect being allied to that of atropine, drying up all the 
secretions. While under ordinary conditions the amount 
of jaborine is comparatively minute, and the drug jabor- 
andi is given to promote the secretions, cases have act- 
ually occurred where it has been found to produce the 
opposite and undesired effect of drying up the secre- 
tions. But, if pilocarpine is used instead of jaborandi, 
no such effect is possible. 

Keeping Qualities of These Drugs 

Thirdly, they are convenient to carry, taking up but 
little space, and having excellent keeping qualities. 
These qualities render them of especial value to the 
country doctor who is far from his base of supplies. Dr. 
Robert Gray, of Pichucalco, Chiapas, Mexico, an Ameri- 
can physician, who has practiced in the most unhealthy 



18 ACTIVE-PRINCIPLE THERAPEUTICS 

belt on the continent, most of the time since the close of 
the Civil War, writes as follows of his own experience. 

"I carry one hundred and fifty-six active principles, 
weighing less than five pounds with case, the equivalent 
of which in galenic forms would load two mules. I am 
never ambushed by the enemy when suddenly confronted 
by some desperate emergency, no matter what the disease 
or the complications may be. I have the antidote while 
the time for medication still remains, and do not have to 
send prescriptions to a. distant drug store for uncertain 
remedies, a makeshif e often fatal to an imperiled life. ' ' 

As for the keeping qualities of the active-principle 
medicaments, they are due in part to the chemical quali- 
ties of the alkaloids themselves and in part to the man- 
ner in which they are held together in the standard 
granule, which is Well known to preserve the medica- 
ments much better, than any kind of coating that can be 
applied to a pill or a tablet. This is well seen in the case 
of calcium sulphide, a drug that is almost certain to de- 
teriorate by keeping when prepared in the ordinary tab- 
let or pill form. Here the superiority of the standard 
granules over the other preparations is very marked. 

While we believe in the superiority of the active prin- 
ciples, as a general rule, cases no doubt are encountered 
in which better results can be obtained from crude drugs 
and their galenical preparations, as well as from the coal- 
tar preparations and other chemical products. When 
this is so, they should be used without hesitation. In the 
words of Shaller, who is one of the first authorities on 
active-principle medication in America, "Any remedy 
that is good and that cures is used, no matter what its 
source or by what school it has been first advocated." 
The greatest need of the doctor is, not the active prin- 
ciples, but definite therapeutics, no matter whether it be 
in the direction of galenic medication, biochemistry, spe- 
cific medication, serum treatment, or glandular therapy. 



FUNDAMENTAL LAWS 19 

Small Doses Frequently Repeated 

The second law teaches the administration of these 
remedies in minimum doses frequently repeated, until 
improvement is manifested or physiologic effects are pro- 
duced. This is known as the intensive method of dosage, 
or dosage for effect. 

I have said that the use of the active principles looms 
highest in popular estimation of all the characteristics of 
this method. But, if this were the only factor, it could 
never rise to the dignity of a system of therapeutics or 
even a method of administering drugs. The first law de- 
termines the tools to be used, the second explains the 
manner in which they should be used. 

The matter of dosage is one of the first importance to 
the physician. In the system in common use — which we 
may term massive dosage — there is a maximum and a 
minimum dose laid down, and these must be learned 
arbitrarily for each drug and every preparation. Very 
likely there may also be an average dose given, which is 
supposed to be the one most commonly used ; yet, if the 
doctor keeps within the limits of the maximum and the 
minimum dose, it is assumed that he is on the safe side 
and cannot be blamed, whether he fails to benefit the 
patient on the one hand or happens to kill him on the 
other — for has he not followed the dictum of the authori- 
ties and given the proper dose? 

Like the spelling book, the dose book usually takes up 
a good share of the student's time when in school, and 
like it, -again, is promptly laid on the shelf when school 
days are over. Of my two teachers of materia medica 
when I was in the medical school, from one of them I do 
not remember that I ever learned much of anything ex- 
cept doses — and I promptly forgot these as soon as I had 
passed my examinations. 

With many remedies, when a maximum dose is given, 



20 ACTIVE-PRINCIPLE THERAPEUTICS 

it is supposed to produce the full effect of the drug, and 
a second is not to be given until the first is eliminated 
from the system. But whether or not it really does pro- 
duce the anticipated effect upon the system, depends 
upon so many factors that no one can foresee what the 
result really will be. 

If the patient is sensitive to the action of this particu- 
lar drug, he may be overwhelmed by a dose that would 
produce no noticeable effect upon another person, even 
though the two might seem to be counterparts. On the 
other hand, we often meet . with patients who are not 
easily affected by drugs of any kind, and hence require 
very large doses in order to secure results. 

How is the doctor to decide in the case of a new pa- 
tient whether the dose which he has administered will 
prove a poisonous one or will fail to produce any notice- 
able effect, either therapeutic or physiologic? 

This Method of Dosage Overcomes a Defect 

The defects of this system of dosage are frankly ad- 
mitted by our best therapeutists. Potter, in his excellent 
"Materia Medica, Pharmacy, and Therapeutics," says: 
"The dosage of medicine is the weakest part of the 
therapeutic armament, the flaw in our weapons which 
may be the cause of their failure at any moment, per- 
haps the most critical one for a life. If the accumulated 
rubbish of ages, which has been called therapeutic 
knowledge, is ever to be given scientific shape or placed 
in the process of becoming a science, the question of 
dosage must form one of the principal corner-stones in 
the foundation. ' ' 

Now, it is this weak spot which active-principle 
therapy has undertaken to strengthen, this chief corner- 
stone which it has set out to put in its proper place in 
the temple of scientific medicine. Already, in the process 



FUNDAMENTAL LAWS 21 

of evolution, in the attempt to build our fragmentary 
therapeutic knowledge into a science, there has been for- 
mulated by the master-mind of Burggraeve and elabor- 
ated by the dosimetrists of Europe and their disciples in 
America, a system of dosage which avoids all the dan- 
gers mentioned and at the same time meets the require- 
ments of safety, accuracy, and convenience. 

This, as already mentioned, we call the intensive 
method, and its fundamental principle is dosage for 
effect. By this method, a minimum dose is given at the 
outset, and this is repeated at frequent intervals until 
the characteristic effect of the drug is secured, either 
therapeutic or physiologic; and then less frequently as 
long as it is desirable to maintain the effect. 

Granules of Minimum Dosage Employed 

As a matter of convenience, the medicaments used are 
nearly all prepared in granules of minimum dosage, so 
that the labor of learning the doses is entirely obviated, 
as the doctor never undertakes to put up his own gran- 
ules. This system is especially adapted to the more pow- 
erful drugs of whatever nature, which are the very ones 
that by the common method give rise to the most anxiety, 
lest ill results should follow their use in maximum dos- 
age, or no results be evident from their infrequent ex- 
hibition in minimum dosage. 

For example : If the doctor wishes to give aconitine in 
a case of fever, he gives one granule, preferably in solu- 
tion, every fifteen to sixty minutes, according to the in- 
tensity <of the fever and the condition of the patient, 
until the remedial effect of the drug is seen by the estab- 
lishment of perspiration, the pulse becoming softer and 
less frequent, the tongue moister and the fever less in- 
tense ; or, failing to get these results, it is given until the 
earliest manifestation of its physiologic action, which is 
seen in the sensation of numbness and pricking in the 



22 ACTIVE-PRINCIPLE THERAPEUTICS 

lips and tongue, extending to other parts, makes its ap- 
pearance. 

The first group of these symptoms shows that the drug 
has done its work and that thereafter it may be given 
somewhat less frequently as long as it is desired to main- 
tain the effect. The second group of symptoms indicates 
that as much of the drug has been given as can be with 
safety and it is time to stop. But in every instance these 
symptoms give ample warning in time to avoid all 
danger. 

This method tends to accuracy in therapeutics. It re- 
lieves the physician of all fear of overdosing and all need 
of learning an arbitrary dose-list. But it requires an 
absolute knowledge of two things on the part of the 
physician: He must know, first, what he wants the 
drug to do — that is, the remedial effect. Secondly, he 
must know what the drug will do if pushed to the limits 
of safety — that is, its physiologic action. These two 
things are absolutely essential. They are best learned 
by studying, in case after case, the action of each drug 
upon the patient, with your own eyes and ears and 
fingers, until you become familiar with their effects. 

This experience in itself will make you a better thera- 
peutist than you could otherwise be. That is one thing 
where the old country doctor, who remained with his pa- 
tients the livelong night, had the advantage of the scien- 
tific young fellow of today, who simply looks at the 
nurse 's chart and prescribes from that. But to be a good 
doctor, you must know the action of your drugs per- 
fectly and be able to tell your nurse or attendant defi- 
nitely what to look for, when to change the dosage, and 
when to stop. Do this, and you will get results. 

Acute Diseases May Be Aborted 

The third law teaches that acute inflammatory and 

febrile diseases may he aborted in a large proportion of 



FUNDAMENTAL LAWS 23 

cases, provided that the proper treatment is begun before 
the occurrence of structural changes. From this fol- 
lows as a corollary the importance of beginning early in 
the treatment of disease. 

Here at last we are brought face to face with a thera- 
peutic principle around which many a hard-fought 
wordy battle has been waged, and the truth of which is 
not even yet accepted by a large proportion of the medi- 
cal profession — namely, the possibility of aborting spe- 
cific and self-limited diseases. It may, therefore, be 
worth our while to spend a few minutes in considering 
the arguments in favor of the principle which I have 
stated, in order that you may determine for yourselves 
whether or not it is true, and whether the resulting corol- 
lary is a safe one. 

Here, with your permission, I will quote some passages 
from a paper entitled, "Can a Specific Disease Be 
Aborted?" which I read before the Worcester District 
Medical Society some years ago and which was after- 
ward published in The Boston Medical and Surgical 
Journal. 

To be on the safe side in this discussion, let us be sure 
of our definitions. 

"Specific disease, a disease which has a determinate 
course and succession of phenomena, and is due to some 
distinct and definite cause, as syphilis or itch." 

" Self '-limited disease, one having a somewhat definite 
course and period of duration. ' ' 

"Abort, to cut short the course or growth of." 
( Standard Dictionary. ) 

In the light of these definitions, the question for us to 
consider is practically this : 

Is it possible for the physician, by any means at his 
command, to cut short the course or limit the growth of 
disease in general; and in particular of such forms of 
disease as are due to more or less distinct cause, and 



24 ACTIVE-PRINCIPLE THERAPEUTICS 

which, when left to nature, develop according to a de- 
terminate course and succession of phenomena, and have 
a somewhat definite period of duration ? To be more spe- 
cific : Can a simple fever be broken up or a local inflam- 
mation be cut short in its early stages? Can you limit 
the course of inflammatory rheumatism or abort a 
typhoid fever, a pneumonia, smallpox, gonorrhea, diph- 
theria, the itch ? Can anything be done to limit the rav- 
ages of the bacillus tuberculosis when once it has begun 
its deadly work? 

The answer which shall be given to these questions is 
of the utmost importance to the physician, as affecting 
his reputation, his success, and the satisfaction with 
which he practices his chosen profession. It is of even 
greater moment to the patients whom he treats, and the 
families under his care, because it helps to determine 
whether their physician shall be a welcome visitor, bring- 
ing hope and added years of life to the sick one, and giv- 
ing courage to his friends and family, or one whose com- 
ing is looked upon with dread, whose presence breathes 
only despair, who admits himself a failure at the outset, 
and who practically counts himself out as a factor in the 
treatment of disease. 

What Authorities Say 

It must be admitted that the weight of authority is 
decidedly against the possibility of aborting a specific 
disease. It is almost universally assumed that a disease 
which has once gotten fairly under way must of neces- 
sity go on its course uninfluenced by medical treatment. 
Should a claim be made that a disease has been aborted, 
the usual answer is that the diagnosis was incorrect ; that 
a disease is not a specific one unless it goes through a 
regular course, and if it does this it certainly is not 
aborted. Hence a specific disease cannot be aborted. 



FUNDAMENTAL LAWS 25 

Just here the question suggests itself, does not nature 
itself sometimes abort disease? Or, to phrase it a little 
differently, do not diseases at times abort spontaneously ? 
The answer to this is evident, and the fact is universally 
recognized by medical authors that such is the case. So 
well is this understood, that the second answer which is 
apt to be made to the claim that a disease has been 
aborted is, that it aborted spontaneously; or that it was 
an abortive case ; or that nature aborts a certain propor- 
tion of cases. In each of these forms of reply, the fact 
of the shortening of the disease from its natural course 
is admitted and the only debatable point relates to the 
possibility of bringing about this result by artificial 
means, that is to say, by medical treatment. 

But, if it be admitted that nature does actually accom- 
plish this beneficent result in certain instances, then 
why should it be deemed impossible that art should be 
able to aid in the process? The law of cause and effect 
is everywhere the same, and it would certainly seem that 
where nature accomplishes a given result under certain 
conditions, it might be within the bounds of human skill 
to aid in bringing about these conditions, and thereby to 
assist in the work. 

Should it be granted that such a result is within the 
bounds of possibility, and that it is also desirable, is it 
not the part of wisdom to seek for the means whereby it 
can be accomplished, instead of crying out in advance 
that it is impossible, that it cannot be done, simply be- 
cause we do not know how to do it or have not the means 
now at hand? The history of medicine shows us that 
every important progress in our art has consisted in the 
accomplishment of that which but yesterday was de- 
clared impossible. It used to be supposed that conscious 
suffering was a necessary accompaniment of surgical op- 
erations; but Crawford W. Long, Horace Wells and Wm. 
T. G. Morton brought anesthesia to light and abolished 



26 ACTIVE-PRINCIPLE THERAPEUTICS 

pain in surgery. Not so long ago as to be beyond my 
memory, it was considered that "laudable pus'* was not 
only unavoidable but desirable in the healing of wounds ; 
but Lister showed the world that it was not necessary, 
and it is now looked upon as a deep and damning dis- 
grace. 

If Diphtheria Can Be Aborted, Why Not Other Diseases? 

But, if the possibility of aborting disease be admitted 
as an abstract proposition, how about it as an actual 
fact ? Are there not instances to prove that in some cases 
at least specific diseases are unquestionably aborted, and 
that by strictly therapeutic measures'? As, for example, 
diphtheria by antitoxin ? What better example than this 
of the abortion of a specific disease can be asked for ? It 
must be admitted that no better example of a specific 
disease can be found than this. It corresponds at every 
point with the definition which has been given. 

Only a few short years ago few persons were rash 
enough to advocate even the possibility of aborting it. 
Today the world accepts it as a fact beyond dispute, and 
the physician who fails to abort a case of diphtheria 
which comes under his care makes haste to explain that 
it did not come into his hands until it was too late, or 
that for some reason beyond his control he was unable to 
administer the proper dose of antitoxin at the proper 
time. It is true there are still a few persons who deny 
the utility of antitoxin, just as there are those who de- 
cry vaccination or who continue to hold that the earth is 
flat and the sun moves round it once in Iwenty-four 
hours. 

If it be admitted that diphtheria can be aborted and 
if the commonly received theory of the action of anti- 
toxin be accepted, is it not within the bounds of reason 
that there may be corresponding remedies for some of 



FUNDAMENTAL LAWS 27 

the other specific diseases, if not for all ? That this sup- 
position is reasonable is shown by the eagerness with 
which the medical world has sought and is still seeking 
for just these things. It is also true that in no other 
disease has an antitoxin been discovered which is as posi- 
tive and beneficent in its effect as is that for diphtheria ; 
but this fact only serves as an incentive to more earnest 
effort on the part of scientific men and as a stimulus to 
scientific research from one end of the world to the 
other. 

Unce more, if this result has been obtained by anti- 
toxin, which is, after all, only a natural product, is it 
not conceivable that similar results may be obtained by 
other means just as natural. And if it be admitted that 
medical treatment exerts any influence whatever upon 
the course of a disease, is it not reasonable to suppose 
that this effect will be most marked during the formative 
stage, when it is not yet fully developed ? 

"Breaking Up" a Fever 

To come down to specific instances, by what strict rule 
of science must it be declared an error to suppose that 
sweating may break up a fever or dissipate a local con- 
gestion? If we rightly understand the functions of the 
vasomotor nervous system and correctly estimate the role 
of vasomotor spasm and paralysis in the genesis of fever, 
is it not reasonable to suppose that means tending to re- 
store the proper equilibrium to the circulation would 
have a tendency to dissipate the febrile paroxysms ? 
And if the febrile condition is removed, is not the fever 
itself aborted, jugulated, broken up, cut short, made not 
to be? 

Furthermore, what doctor in his practice does not 
strive, when he is called in the formative stage of a 
fever, to ' ' break it up " ? What one does not encourage 



28 ACTIVE-PRINCIPLE THERAPEUTICS 

the patient and his friends to hope that this result may 
be obtained ? And, should he fail to bring it about, what 
medical attendant does not gently intimate to the pa- 
tient's family that he might have succeeded had he been 
called a little earlier in the case ? 

Now the question is, Are the doctors frauds in this 
matter or do they build better than they know? Is not 
their practice better than their theory? Do they not, 
by their practice, confess that the doctrine of the jugula- 
tion of fevers is a reasonable one? Does it not, indeed, 
work well in practice? 

If antitoxin can abort diphtheria after it has gotten 
fairly under way, and if it renders a healthy individual 
temporarily immune to the toxin of diphtheria, then why 
should it be considered an absurdity to suppose that it 
can act upon the disease in the stage of incubation? And 
if antitoxin can do this, why not other agents? Even if 
no such agents are now known, may they not some time 
be discovered? And, if this possibility be admitted to be 
a reasonable one, why not search high and low for the 
means until they are found? 

If mercury be a specific in syphilis, then why may it 
not act upon the disease in its incubative and formative 
stages, as well as after it has fully declared itself? Or, 
if not mercury, then some other remedy? Or why, if 
we were in possession of the proper remedy, might not 
the disease be aborted in the interval between the pri- 
mary chancre and the secondary manifestations ? If we 
possessed a specific in smallpox, why might we not ex- 
pect to be able to abort the disease in the stage of incuba- 
tion as well as to render the subject immune by vaccina- 
tion or control the symptoms of the eruptive stage? If 
diphtheria can be aborted, why not pneumonia, typhoid 
and malarial fevers, gonorrhea, syphilis, rheumatism and 
consumption? 

Should the answer to this last question be that we are 



FUNDAMENTAL LAWS 29 

not yet in possession of the proper remedies and means 
to enable us to accomplish these results, however much 
as we may desire to do so, I beg to remind you that it is 
but a few years since we had no organic extracts, no 
serum therapy, no intestinal antiseptics, no nuclein, and 
almost no alkaloids. 

Would it not, then, be better to admit the possibility 
of improvement and then go to work with all our might 
to make the possibility a reality, instead of spending our 
time in crying out, " It is impossible, it is absurd, it can 
not be done?" — a cry which has been uttered by every 
reactionary in the face of all progress since time began. 

The Importance of Beginning Early 

Coming now to the corollary, or deduction, of the im- 
portance of beginning early in the treatment of disease, 
we find nothing in it that is especially new, nothing to 
which most physicians will not readily agree. 

The peculiarity of active-principle therapeutics in re- 
lation to this truth lies, not in its acceptance, but in the 
emphasis which is placed upon it. As to the fact, there 
is little difference of opinion among physicians. It re- 
mains for the disciples of dosimetry to insist upon its su- 
preme importance and to urge its acceptance by the pa- 
tient as an essential factor in the successful treatment 
of disease. He educates his patients systematically to 
send for their physician at the earliest indications of 
acute disease, and that not as a. favor to the doctor but 
to benefit themselves. 

From the doctor's own point of view, he will have 
more first calls, but fewer protracted sicknesses; more 
slight illnesses, but fewer fatal outcomes. The bills will 
be smaller in the individual cases but they will be sent 
in oftener and paid more promptly. And, surely, con- 
sidered even from a financial standpoint, a live patient 



30 ACTIVE-PRINCIPLE THERAPEUTICS 

is worth more than a dead one. Hence such a course will 
be of advantage to the doctor as well as to the patient. 

When the physician is called to a case of disease at the 
outset, he does not have to wait until he can make a 
positive diagnosis before he begins the treatment. He 
does not need to spend a week in watching the develop- 
ment of the malady, meanwhile making daily visits of 
inspection but lifting no hand in defense of the imperiled 
vital forces. 

Instead of this it is his privilege to treat the diseased 
conditions as he finds them and as they are indicated by 
the earliest symptoms in the case. He knows how to 
treat the elementary conditions of disease, even before 
the causes are evident and before a complete diagnosis 
is possible. Knowing the rational indications for early 
treatment, he is often able to prevent the development of 
pathological lesions and to see the patient restored to 
health without ever knowing the name of his disease. To 
be sure, this is an inexcusable sin in the eyes of the path- 
ologist and one on no account to be countenanced. But 
the patient and his friends are usually well satisfied, and 
as they are the ones who pay the bills and recommend 
the doctor he ought not to be the one to find fault. 

You will remember that I told you last week that 
Burggraeve, the originator of dosimetric medicine, which 
was the original of modern active-principle therapeutics, 
states that "dosimetric medicine rests essentially upon 
its power to jugulate those fevers in which all acute mal- 
adies have their commencement. Its great end is to pre- 
vent anatomo-pathologic lesions, for these once estab- 
lished are beyond the resources of art. ' ' 

This is only another way of stating the law which we 
have been considering; and you will readily see that the 
only way in which these results can be accomplished is 
by beginning early in the treatment of any disease. To 



FUNDAMENTAL LAWS 31 

sum up, then, we may include the essentials of active- 
principle therapy under the three following heads : 

1. The materials, which are the active principles, in 
the main. 

2. The method, which is the intensive method of 
dosage. 

3. The object, which is the abortion of disease; and 
this leads to the resulting rule of action : Begin early. 

On these three principles hang all the minor peculiari- 
ties of the system — of which I shall tell you more next 
week. 



CHAPTER III 

The Minor Peculiarities of Active-Principle Thera- 
peutics 

THE difference between a living language and a 
dead one is, that the one is always changing, grow- 
ing, developing, adding, subtracting, dividing; while the 
other is finished, fixed, unchanging, mathematically 
complete. 

The system of active-principle therapeutics is like a 
living language. It is not only alive, but it is still in 
the process of making, growing, undergoing develop- 
ment. Hence it is not subject to any fixed and un- 
changing laws. Even the principles which I stated to 
you last week as fundamental might be worded quite 
differently by another, and may be changed by common 
usage in another decade. And so it is that, when we 
come to consider the minor peculiarities of the system, 
the best I can do is to state the case as it seems to me. 
My neighbor might with as good reason state it differ- 
ently. 

But as I have been a student and practitioner of 
active-principle therapeutics for twenty years, I shall ex- 
ercise my right as an oldtimer to state its peculiarities as 
they seem to me, and leave it to someone else to make 
such changes in phraseology as he may desire or as fu- 
ture developments of the methods of practice may war- 
rant. No one can speak with absolute authority in the 
matter. 

Use Single Remedies and Simple Combinations 

1. The first peculiarity to which I shall call your at- 
tention is the predominant use of single remedies and of 
simple combinations. And even this is not entirely a pe- 
culiarity of this system, as it is the common practice of 



34 ACTIVE-PRINCIPLE THERAPEUTICS 

the Homeopathists and Eclectics, and the trend of recent 
usage in the regular school is decidedly in the same di- 
rection, and away from the shotgun prescriptions and 
countless combinations, secret preparations, and proprie- 
tary remedies in such favor a few decades ago. 

Only by using a single remedy at a time is it possible 
to determine the action of that drug with any degree of 
accuracy. When you come to make the practical ac- 
quaintance of the drugs you use daily ( and you must do 
this if you hope to be good therapeutists), you will find 
that it is a work requiring infinite pains and patience 
and manifold repetitions, at the best, to determine the 
action of any given simple drug. And when you come 
to combine with this one drug one or more other drugs 
of different action, the difficulties are increased in a. geo- 
metric ratio. 

When, however, the action of each individual remedial 
agent has been singly and definitely determined, it is 
then possible to build up with care a few standard com- 
binations the components of which, while modifying, yet 
assist each other in their action. Also, on occasion, ex- 
temporaneous combinations may be made to meet the 
changing conditions under certain conditions ; but be- 
yond this, the majority of physicians will find it advis- 
able not to venture. 

I have known but one practitioner whom I felt that I 
could trust to write a complex prescription, with full 
confidence that he would combine the various ingredients 
so as properly to adapt the resulting compound to the 
conditions in question. This man was a master of his 
art and could see the end from the beginning. But for 
the most of us the single remedy is capable of doing bet- 
ter work than any complex prescription. 

Definite Indications for Use 

2. Predicating definite indications for the use of rem- 
edies constitutes the second peculiarity of our practice. 



MINOR PECULIARITIES 35 

While it cannot be claimed that this feature is confined 
to the user of active principles, it surely is emphasized 
by him in his practice. He gives his remedies, not for 
diseases as such, but for the definite conditions which oc- 
cur in the course of disease. When it is once determined 
what conditions of disease may be met by any remedy, 
then this remedy can be relied upon as of value wherever 
that condition is found. The skill of a physician is best 
shown in determining the exact condition which is met 
by any drug. As an illustration of this principle, I have 
been closely studying for ten years a little-known drug, 
i. e., verbena hastata, in the endeavor to determine its 
precise indications in cases of epilepsy. That is, I have 
tried to find out what class of cases and what character- 
istic symptoms were benefited by this drug, and which 
ones were not helped or might even be made worse. In 
this ten-years' time I have succeeded in developing five 
fairly definite indications — one for every two years ! 

The Granule the Preferred Form of Medication 

3. TJie soluble granule is chosen by us as tlie prefer- 
able form of medication in most cases. Competent phar- 
macists declare that the soluble alkaloidal granule is the 
highest development of the pharmaceutical art. While I 
am not in any way capable of describing the method of 
their manufacture, I do know that the perfected result 
has many virtues. Small in size, always readily soluble 
in hot water, capable of retaining its full remedial vir- 
tues for an indefinite period, it may be given either in 
granule form followed by a drink of water or in aqueous 
solution, as may be preferred. It thus combines the vir- 
tues of liquids and solids. 

Clean Out and Keep Clean 

4. The dogma of " clean out, clean up, and keep 
clean," as taught by Abbott and Waugh and practiced 
by their followers in America, is coming more and more 



36 ACTIVE-PRINCIPLE THERAPEUTICS 

to be accepted as therapeutic gospel. It is based upon a 
recognition of the importance of autointoxication as a 
cause of disease, and of absorption from the intestinal 
canal as a prime cause of autointoxication. 

Treatment begins with elimination from the intestinal 
tract: calomel and podophyllm, in small doses, and the 
laxative salines, being the favorite agents for this pur- 
pose. These are followed by or associated with the use 
of intestinal antiseptics. The endeavor is to produce, 
with these two classes of measures, not indeed complete 
intestinal asepsis, but that which is at least partial, and 
it is very effective therapeutically in most cases. The 
agents most commonly used as intestinal antiseptics are 
the sulphocarbolates of calcium, sodium, and zinc, either 
singly or in combination. The results of the use of these 
intestinal antiseptics in the treatment of typhoid fever 
and allied diseases is certainly very satisfactory. 

There has been much discussion concerning the pos- 
sibility of securing an aseptic condition of the intestinal 
canal. The active-principle therapeutist believes that, 
while it is admittedly impossible to secure and maintain 
absolute asepsis, yet the comparative degree which is at- 
tained makes it vastly easier for the defensive forces of 
the system to overcome the remaining millions of foes 
than it would be if their number were many times larger, 
as a result of a continued bathing of the intestinal canal 
in fecal poisons. 

Seek Systemic Asepsis 

5. The importance of systemic asepsis and antisepsis 
also is maintained as a companion doctrine to that of in- 
testinal antisepsis. Of the numerous drugs which are 
used for this purpose, perhaps the most important are 
calcium sulphide and echinacea. It is found that many 
even of the contagious diseases may be prevented by 
saturating the system of the exposed persons with cal- 



MINOR PECULIARITIES 37 

cium sulphide. I myself have repeatedly proved the 
power of this drug to prevent scarlet-fever, and have 
come to consider it a satisfactory substitute for quaran- 
tine in many cases. I will give you one illustration as 
typical of the whole. 

A woman of thirty-five was taken down with scarlet- 
fever, which ran a typical and moderately severe course. 
During her illness, the house was strictly quarantined by 
the board of health, three persons besides the sick woman 
being confined therein during the whole time. These 
were her husband, her little daughter of some eight or 
ten years, and the husband's sister. None of them had 
ever had the disease, and all were confined in the house 
and went in and out of the sick room with perfect free- 
dom from first to last. 

From the onset of the disease, I saturated them all 
with calcium sulphide, giving one gra.in four times a day 
to the child, and six to eight times a day to each of the 
adults. The smell of sulphureted hydrogen was obvious 
in the breath of each one, and this is essential to the 
proper result. This course was continued until the pa- 
tient recovered and the quarantine was removed. 

Not one of the exposed persons contracted the disease. 
It may not be considered strange that the adults es- 
caped, but the child would certainly have been expected 
to contract the contagion. I do not claim that this case, 
or any one case, proves anything absolutely, but I cer- 
tainly feel that I have had enough such cases to justify 
me in relying upon calcium sulphide as a satisfactory 
systemic antiseptic and as a means of preventing con- 
tagious disease, in a large proportion of cases, at least. 

Vasomotor Equilibrium 

6. The importance of the vasomotor system in those 
congestions with which almost all acute diseases begin 
is emphasized in this system of medication, and has been 



38 ACTIVE-PRINCIPLE THERAPEUTICS 

especially taught by Dr. Waugh. The latter makes the 
following assertion : ' ' Circulatory disturbances herald 
the beginning of every acute attack and form an essen- 
tial part of the phenomena presenting themselves 
throughout its course. Acute inflammatory attacks be- 
gin with a disturbance of the circulatory equilibrium. 
The affected part fills up with blood, which distends the 
capillaries, whose walls, relaxing under the increased 
pressure, afford an example of relative vasomotor 
paresis, being abnormally weak in comparison with the 
pressure to which they are subjected. But as there is 
no reason to suppose that the actual quantity of blood 
in the body has been increased, this overplus of blood in 
the distended capillary area indicates that there is too 
little blood in some other part of the vascular system. 
In other words, the vasomotor paresis in the hyperemic 
area is exactly compensated by a vasomotor spasm in 
some other vascular area." 

It is for this reason that the fever remedies which are 
used by the active-principle therapeutist are selected ; i. 
e., because they act on the vasomotor nervous system. 
Of this we shall learn more when we come to take up the 
subject of the treatment of fevers. 

Selective Function of the Cell 

7. The selective function of the cells, by which they 
are enabled to choose from the blood those elements 
which they have need of and appropriate them for the 
supply of their wants, while at the same time they re- 
ject all other elements and send them along to be used by 
such other cells as may have need of them, is another of 
the doctrines which guide the user of active principles in 
the intelligent choice of his remedies. 

Stated a little more at length, the theory may be illus- 
trated as follows: In the general blood stream, as it 
comes pouring out of the lefl side of the heart and goes 



MINOR PECULIARITIES 39 

pulsing through the arteries to every part of the system, 
there is to be found every kind of matter that goes to 
make up the different tissues and structures of the body. 
There is oxygen to purify the blood and revivify the tis- 
sues, phosphorus for the brain and nerve-cells, calcium 
for the bones, nitrogen for the muscles, and the proper 
materials for all the different kinds of cells, serous, mu- 
cous, muscular, glandular — in short, the things which 
are needed for every part of the body. 

Nor can the material which is intended for the nutri- 
tion of one part be made use of by any other part. Each 
cell claims for its own and takes unto itself that kind of 
material, and only that, which can be elaborated in its 
own factory and made up into the substances which it 
needs and uses in its daily life and work. Unto each 
part its own, and every part unto its own kind, is the 
law of life. So all through the different parts of the 
body this one fluid, the blood, goes coursing on its way, 
while at every station there are thrown off from the 
blood and taken up by the cells those particles of matter 
that are needed at this particular station, and only 
these. There is a selective affinity of each part for its 
own material. The hair-cells pick out with unfailing ac- 
curacy those substances which go to the making up of 
hair. The liver chooses only those materials which can 
be changed into sugar and bile, and the other liver ma- 
terials and liver products. 

Again, the quantity which is normally appropriated 
by any cell is the amount that is needed to restore and 
preserve the proper physiologic equilibrium, or proper 
balance, of the functions. As the processes of waste are 
always going on, so the repair of the tissues must go on 
apace, and these two are normally equal, no more being 
taken up by the cells that is needed to carry on the 
natural functions of the part, or than can be carried off 
by the organs of excretion. 



40 ACTIVE-PRINCIPLE THERAPEUTICS 

To be sure, just as in nature everywhere we find a 
normal action and an abnormal one, so here there is such 
a thing as loading down the circulation with matter 
which is not needed by any of the tissues, yet which can- 
not be gotten rid of except by the regular physiological 
processes of nutrition, and hence it has to be taken up 
by the cells ; and there is such a thing as overburdening 
the system with the best of materials, so that the cells 
will take up more than they need, more than they can 
properly dispose of. In either case, the result is that 
the functions dependent on these cells are depressed in 
their character, or are unduly stimulated, or are ren- 
dered abnormal. We then see symptoms of innutrition, 
of overnutrition, or of poisoning. 

This scheme of adaptation is only in the line with 
what is done by reasoning creatures in meeting material 
needs every day, for there are none of us who live up to 
our light and knowledge all the time and under all cir- 
cumstances. We all of us eat too much at times, and of 
improper food at tha.t. If we did not, there would be 
few cases of colic, or typhoid fever, or gallstones, or 
rheumatism to treat. Nature carries on her opera- 
tions automatically to a certain extent, it is true, but she 
makes false steps at times, and needs an intelligent mind 
to direct her in her work. 

To carry this theory a little further, the principle 
which we have stated holds true not only for food and 
dietetic materials, but as to medicinal and drug sub- 
stances. When active remedies are given in small 
amounts and repeated at the proper intervals only, we 
find that there is produced a definite effect (and if the 
drug administered was the indicated one in this condi- 
tion, then it is a remedial effect) on some definite organ. 
tissue, or structure; while the other organs, tissues, and 
structures are apparently uninfluenced thereby. 

To illustrate: Hydrastis has an especial action on the 



MINOR PECULIARITIES 41 

mucous membranes; bryonia influences especially the 
serous membranes; jaborandi acts primarily on the 
sweat-glands and in a less degree on other excretory 
glands. Strychnine is the great nerve tonic, while iron 
builds up the blood ; but, if too much strychnine or any 
other active substance is administered, it is not in the 
power of nature properly to dispose of the additional 
quantity, and harm results to the individual. The same 
is true of all remedial substances, in greater or less de- 
gree, in proportion to their activity and their power to 
accomplish good or ill. 

In reliance upon this principle of nature, the user of 
the active principles does not hesitate to give a.conitine 
and strychnine at the same time in a case of vasomotor 
congestion, knowing that the spasm will be relaxed by 
the action of the aconitine and the paresis be toned up 
by the strychnine, each without interfering with the 
action of the other, in accordance with the principle of 
the selective function of the cells. But, if the dose be 
increased beyond the ordinary medicinal one, then the 
cells may be overwhelmed and poisoned by the addi- 
tional quantity. 

Definite, Positive Results Are Sought 

8. Active-principle therapeutics aims to secure defi- 
nite, uniform, and positive results from its use of med- 
icaments, and in order to do so two things are requisite. 
First, its remedies must be absolutely reliable; and this 
it aims to secure by the use of the active principles pre- 
pared in the granule form by reliable manufacturers. 
Secondly (and here I am only repeating, to emphasize 
what I have already said more than once), the man who 
uses these drugs must have a definite knowledge of the 
action of his remedies, of the symptoms which indicate 
both their remedial and its physiological action, and, 
also, must know the natural history of the diseased con- 



42 ACTIVE-PRINCIPLE THERAPEUTICS 

dition which he treats, in order that he may understand 
what would happen if the case were left to nature, and 
what he desires to produce by medicinal treatment. 

The best way that I know of for a young doctor to se- 
cure this knowledge is for him to sit the livelong night 
by the side of his patients, watching the symptoms with 
his own eyes, administering the remedies with his own 
hands, and storing up the resulting lessons in his own 
brain-cells. That is the way to become a good thera- 
peutist. Especially it is the way to learn the successful 
use of the active principles in accordance with the meth- 
ods which I am advocating. 

Active-Principle Therapy Not Sectarian 

9. Active-principle medication, as a system of treat- 
ment, is not the basis for a new sect, f ism, 'patJiy or any 
separatist school of medicine. Rather it seeks to obtain 
adherents among practitioners of every school, and with- 
out regard to any of these matters. It fights for its 
laurels on the firing-line of disease and proves its su- 
periority by actual trial at the bedside. In order to en- 
ter its ranks, one does not need to renounce any old the- 
ories or take upon himself any new vows. It has no 
forms of initiation, no badge, no regalia, You read its 
literature, and, if its claims attract you, yon send for a 
case of the granules and try them in your practice. 

A friend of mine writes me that he carried his alka- 
loidal case around with him for a year or two before he 
dared to try its contents. Then he was called in con- 
sultation by a brother physician, to see a boy of eight or 
ten years, sick with pneumonia. The case apparently 
was an exact reproduction of that of an older brother, 
who had been sick then for some ten days, and later ran 
a long course of double pneumonia, with, . still later, 
empyema and various other serious complications, but 
who finally recovered. The boy that he saw had been 



MINOR PECULIARITIES 43 

sick thirty-six hours, had a temperature of 105 degrees 
F., pulse 140, respiration 50, with the middle and lower 
lobes of the right lung solid, with all the classical symp- 
toms of pneumonia, including delirium, restlessness, and 
expectoration — "If I know pneumonia," he adds; (and, 
as he was a Harvard graduate, he must have known 
pneumonia!) The attending physician was at his wits' 
end and willing to try anything. 

"Then," my friend says, "I gave the little fellow a 
defervescent granule, containing aconitine, veratrine and 
strychnine, every fifteen minutes for two hours, then one 
every half hour for four hours, then one every hour 
until the fever dropped, telling a competent nurse to 
watch results and act accordingly. The result was mar- 
velous, however the skeptics may explain it, for the 
symptoms began to abate at once, and in forty-eight 
hours the temperature, pulse and respiration were nor- 
mal, cough gone, mind clear, and patient quiet, except 
as he was ' hollerin ' like a Tammany chief for something 
to eat. He made a quick and uneventful recovery." 

And this is the way that a good many doctors begin 
the new way of treatment. 

10. Although the best title for our method is that of 
"active-principle therapeutics," yet the materia medica 
of the practitioner of this method by no means is confined 
to the active principles.. Instead, he uses any and every 
means and method which experience and experiment 
have shown to advance the end in view — which is, the 
welfare of the patient. He is not a sectarian, but a 
physician, who seeks out of the vast storehouse of nature 
those things, new and old, which will produce results. 

11. Its basic therapeutic maxim is, " The smallest 
possible quantity of the best obtainable means to produce 
a desired therapeutic result." This is the phrasing of 
Abbott, and it covers the use of remedies of any and all 
kinds. 



44 ACTIVE-PRINCIPLE THERAPEUTICS 
Just "Common Sense" 

At the risk of having you reply to me that I am beg- 
ging the question, I am going to claim boldly another 
peculiarity of this method and its practitioners, which 
I shall call common sense in the use of remedies. To 
illustrate what I mean, I will repeat a little story that 
used to be told by an eminent professor in the medical 
school from which I was graduated. 

The story relates to one of the early graduates of the 
school, and is intended to show the need of common sense 
and good judgment in the practice of medicine. As the 
story was told long before the days of active-principle 
treatment, I must admit that it does not apply exclu- 
sively to their users today. Indeed, I am quite sure 
that the students and graduates of this school, whether 
or not they may accept all the principles which I have 
advocated, will agree with me as to the importance of 
this qualification. 

As a student, the young man in question was a prod- 
igy of information and never forgot what he had once 
been taught. On examination day, he was able to answer 
every question of the professors, to quote the opinion 
of any author whom he had studied, tell on what page 
of the book this opinion might be found, and repeat the 
very words in which it was expressed. As a graduate, 
he carried off the highest honors of the school, and as 
a practitioner he was expected to reflect honor upon his 
alma mater. After receiving his diploma, the newh 
fledged M. D. spent a few weeks with his former pre 
ceptor in medicine, visiting patients with him, as Mas 
the custom in those days, and observing carefully the 
treatment and its results. 

Among the patients treated during this time was one 
who had typhoid fever. The patient was a robust and 
full-blooded man, in whom the fever ran high, as was 



MINOR PECULIARITIES 45 

usual in such cases — a typical sthenic case, we should 
call it. The old doctor treated him according to the 
fashion of the times, with an emetic, a purge, and the 
lancet ; then another emetic, a cathartic, and more bleed- 
ing ; and finally winding up the antiphlogistic treatment 
with a dose of calomel and jalap, ten grains of each — 
"the double ten," as it was called. The patient, being 
of a rugged constitution and well calculated to bear de- 
pleting measures, survived the heroic treatment, and 
soon recovered his usual health. 

Soon after this young medico set up for himself in 
the practice of his profession. His field of labor was 
at a considerable distance from his former home, and 
more than a year had passed before he met his old pre- 
ceptor again ; and when he did, he seized the first oppor- 
tunity — as you will do under similar circumstances — to 
talk of the remarkable cases with which he had been 
confronted during the year, and the wonderful cures he 
had performed. Finally he had made an end of these, 
and — "Now, doctor," the young man continued, "there 
is one thing I don't understand, and I wish you would 
explain it." 

"Very well," said the old man, "state the case." 

' ' Well, doctor, ' ' the young physician responded, ' ' you 
remember that typhoid-fever patient whom you treated 
last summer when I was riding with you after I was 
graduated?" 

"I do, " assented the other. 

"You remember how you treated him?" 

"Yes." 

"And he got well!" 

"Certainly." 

"Well, doctor, I had a case just like that one; I 
treated the patient exactly as you did; and the man 
died!" 

' ' Is it possible ? ' ' Died, did he ? " 



46 ACTIVE-PRINCIPLE THERAPEUTICS 

"Yes, he died; and I don't understand it. I wish 
you would tell me what the reason was." 

"What kind of a man was he, anyway"?" 

"Oh, he was a little fellow, all weasened and dried 
up and thin. 

"You are sure he had typhoid fever?" 

"Oh, yes, all the symptoms." 

"And you treated him just as I did my patient?" 

"Exactly." 

"And he died?" 

"Yes, and I don't understand it." 

"Did you give him an emetic?" 

"I did." 

"And bleed him?" 

"Two or three times." 

"And purged him?" 

"Repeatedly." 

"And wound up with calomel and jalap, ten and 
ten?" 

"Yes, sir." 

"And he died?" 

"Yes. And, now, what was the trouble?" 

The old man leaned back in his chair, drew a long 
breath, and seemed lost in thought for a few minutes. 
Finally he spoke. 

"H'm! doctor, do you remember the old sorrel mare 
I used to drive?" 
He did. 

"Well, one morning in April, five or six years ago, 
I had to go out on the west road, through the woods 
and over the hills, some six or eight miles, to see a 
sick man. It was a warm morning, the frost was just 
coming out of the ground, and the road in some places 
was quite springy. Finally we came to a clayey piece 
of ground, and the old mare got stuck in the clay. The 
more she tried to get out, the deeper she got in, until 



MINOR PECULIARITIES 47 

finally she was in almost up to her belly. I tried the 
best I could to help her out, but the more I tried, the 
more I couldn't succeed. At last I called to some men 
who were plowing in the field not far away, and they 
came over and helped me. We got some rails from off 
the fence near by, put them under her body, and so pried 
and lifted and pulled away until finally we got her out. ' ' 

Pausing a moment to take breath, the old doctor went 
on again: 

"I didn't have to go over that road again for six 
months, and that was late in the summer, and the roads 
were dry and hard. But the moment we came to the 
place in the road where she got in the spring before, 
the old mare stopped short and obstinately refused to 
budge an inch. I touched her up smartly with the whip, 
but she would not go on that way. I got out and tried 
to lead her over, but even that did no good. So finally 
I had to back her out of the road into the ditch, turn 
out into the fields, and let her go away out around the 
place where the clay-pit used to be, though now it was 
as firm and hard as any piece of ground on the road." 

Here the old doctor ceased. His story was told, but 
young Esculap did not see the point. 

"But, doctor, what has all that to do with my 
typhoid-fever case?" 

' ' Young man, you were a good deal like that old mare. 
She had a most excellent memory, but d — d poor judg- 
ment. Circumstances alter cases, young man; circum- 
stances alter cases." 



CHAPTER IV 

The Materia Medica of Active-Principle Therapeutics 

I ONCE heard a physician say, after twenty years spent 
in the practice of medicine, that his faith in drugs 
grew less with each year of his practice. Incidentally I 
noticed that this same man used large amounts of power- 
ful drugs, in spite of his skepticism. But what would 
you think of a mechanic who should tell you that the 
longer he worked at his trade, the less confidence he had 
in his tools? Either he uses poor tools, or he is an in- 
competent workman. If the fault is with his tools, let him 
get better ones. If the trouble is with him, let him serve 
his apprenticeship anew and learn to work with greater 
skill. 

A competent workman ought to have the best tools 
obtainable, and he ought to become more skilled in their 
use and able to do better work with them the longer he 
uses them. The same thing is true with the doctor. 
It is a poor comment on his ability and skill if, after 
twenty years spent in the practice of his profession, he 
cannot do better work than when he first began. 

Why Doctors Lack Faith in Drugs 

It seems to me that there are two reasons which may 
account for our lack of faith in our remedies. One is, 
tha.t we are not using the very best drugs to be had. 
Perhaps we are employing the crude drugs of our fath- 
ers' day, when we ought to be using the active principles 
of the twentieth century. From herb teas to alkaloidal 
granules is a long step, but it must be taken if we hope 
to secure the best results. 

The other reason is, that we have not made ourselves 
masters of the drugs we use. We do not know them as 
we ought to, we cannot handle them as we should. We 



50 ACTIVE-PRINCIPLE THERAPEUTICS 

do not know them, because we do not study tkem — as it is 
our business to do — carefully, critically, thoroughly, con- 
stantly. We do not have the skill in handling them that 
we should possess, because we lack that kind of practice 
which makes perfect. It is not the number of patients 
a man treats that gives him experience, but the amount 
of study, observation, and reflection he gives to each in- 
dividual case. One man gets more experience out of a 
dozen cases than another does out of a hundred. 

In my student days in medicine, I studied the general 
subjects of therapeutics and materia medica under 
two different professors in different schools. Both were 
excellent men, of good ability and attractive personality. 
One of them taught materia medica pure and simple — 
at least, that is the only part of which I have retained 
any recollection. The list of doses took up a good part 
of our time, and, so far as I was concerned, were soon 
forgotten. The origin and physical characteristics of the 
drugs were described minutely, but what good it ever did 
me is more than I can tell. 

In the olden days, when the doctor gathered his own 
herbs and made them up into teas, tinctures and pow- 
ders, such knowledge was a necessity ; but now that the 
manufacturing pharmacist has taken all these things off 
our hands and we have to deal only with the perfected 
and prepared remedies, it seems to me tha.t we waste 
valuable time in studying these things. As for the real 
science of therapeutics, he may have told us consider- 
able, but he certainly did not teach me much — much 
that I have remembered, at least. 

The other professor taught therapeutics, and he taught 
it well. I do not recall that he had much to say about 
doses or the physical properties of the drugs, but he did 
teach their uses. He grouped the more important ones 
into classes, such as cathartics, stimulants, sedatives, nar- 
cotics, and the like. Then he pounded away at the prin- 



MATERIA MEDICA 51 

cipal uses, until we simply could not forget them. The 
differences between the virtues of opium and belladonna 
were explained with care, and then hammered into us, 
so that they remain in my memory to this day. I learned 
some things from this man that have stood by me all the 
years since. I remember that teacher with gratitude 
to this day. 

Now, I have neither the skill nor the time to teach you 
therapeutics and materia medica in that way. All that 
I can do, all that I shall try to do, all that I want to do 
is, to mention briefly some of the principal drugs at pres- 
ent used by progressive physicians, and dwell particu- 
larly upon a few of the most important ones, especially 
those employed in the treatment of fever. 

The Armamentarium of the Progressive Practitioner 

The active-principle therapeutist chooses drugs which 
are small in dose, potent in effect, uniform and reliable 
in action. The majority of these remedies are the active 
principles of medicinal plants, which he uses more often 
than any others, and often uses them in a different way 
and for a different purpose than does his neighbor the 
crude drugs from which the principles are derived. 

Nevertheless, it must be remembered that it is impos- 
sible to practice medicine successfully with the aid of 
granules alone; for there are quite a number of impor- 
tant remedies, such as the iodides, bromides, acetanilid, 
phenacetin, bismuth, the salicylates, the sulphocarbolates 
and many others, which have to be given in larger doses 
than can be incorporated in granules. For this reason 
the list which I shall present by no means will represent 
a complete materia medica. 

Most of the remedies named are prepared in granules 
representing a. minimum adult dose ; and these, in acute 
diseases, may be administered every fifteen minutes, 
every half hour or every hour, according to the severity 



52 ACTIVE-PRINCIPLE THERAPEUTICS 

of the attack, until some improvement is manifested or 
physiologic effects are produced. The medicines should 
then be given at greater intervals for as long as it is 
desirable to keep up the effect. By following this method 
closely, it is simply impossible to overdose the patient. 
You will also observe that the method is exceedingly 
simple, while the labor of committing a list of arbitrary 
doses is entirely done away with. 

Aconitine and Veratrine, to abate fever. Standard 
granules; crystalline aconitine, 1-800 grain; veratrine, 
1-128 grain. These two are the great fever-remedies. 

The specific indication for aconitine in fevers is the 
small and frequent pulse; for veratrine, the full and 
bounding pulse. This is only another way of saying that 
aconitine is the preferable remedy in asthenic cases, and 
veratrine in sthenic ones. They are the remedies es- 
pecially in the early stages of fevers and inflammation. 
When they are continued through the later stages, it is 
frequently desirable to combine with them certain other 
remedies designed to sustain the heart and nervous sys- 
tem. 

For each of these two drugs there are other minor 
indications, some of them of considerable importance ; 
but those named are the ones for which they are most 
frequently employed and the only ones of which we will 
speak at this time. The granules are best given dis- 
solved in hot water, especially when quick action is de- 
sired; but under some conditions the granules may be 
swallowed with a drink of water. 

Digitalin, to sustain the heart. Germanic digitalin 
is commonly used and is a mixture of three of the 
glucosides of digitalis; digitalein, digitonin, and digi- 
talin. Standard granule, 1-64 grain. 

Digitalin is the great cardiac and vascular tonic ami 
stimulant. In moderate doses, it slows the pulse and 
increases the arterial tension, hence, is indicated when 



MATERIA MEDICA 53 

there is a rapid heart-beat and a feeble pulse. It is 
contraindicated to some extent in aortic disease and in 
fatty degeneration of the heart. In certain conditions, 
it may be given in much larger doses than here stated. 
It may be administered hypodermically as well as by 
the mouth. By reason of its action on the heart, digitalin 
antagonizes to some extent the fever-processes and so 
often is given in combination with aconitine and vera- 
trine for this purpose. 

Strychnine and its salts, to combat vital prostration. 
The salts of strychnine, most used are the arsenate, sul- 
phate and nitrate, — the latter being the preferable one 
for hypodermic use. Standard granule, both of the sul- 
phate and the arsenate, 1-128 grain. 

Potter states that strychnine exalts all the functions 
of the spinal cord — reflex, motor, vasomotor, and sen- 
sory, the latter being least affected. When it is desired 
to secure its remedial effects, it should be given in mini- 
mum dose every half hour or hour until either the reme- 
dial effects or the earliest symptoms of the physiologic 
action — restlessness and trembling, with muscular 
twitchings — are manifest, after which it should be given 
in lessened frequency as long as necessary to continue 
its effect. 

The Two Dosimetric Triads for Fever 

These four drugs — >aconitine, veratrine, digitalin, 
strychnine — are the great active-principle remedies for 
fever. Singly or combined they meet most of the indi- 
cations, and do it with an ease and certainty not other- 
wise obtainable. To accomplish this more perfectly, two 
combinations have been added. 

The Defervescent Combinations 

The first of these is known as — 

The Dosimetric Trinity. The formula of this combi- 
nation is: crystalline aconitine, 1-800 grain; digitalin, 
1-64 grain; strychnine arsenate, 1-128 grain. 



54 ACTIVE-PRINCIPLE THERAPEUTICS 

The second of these is called — 

The Defervescent Compound, and its formula is: 
crystalline aconitine, 1-800 grain; veratrine hydro- 
chloride, 1-128 grain; digitalin, 1-64 grain. 

By the action of the dosimetric trinity, the heart is 
sustained and the nervous system toned up. I know it 
often is taught — and presumably you have been so 
taught — that tonics for the heart and nervous system 
should never be given in fever until there are evident 
manifestations of failure of these organs. That is to say, 
digitalis should not be given until there are signs of 
heart failure ; strychnine not until vital prostration su- 
pervenes. This seems to me like saying that a man should 
not go to work to earn any money until his means are 
entirely exhausted, or as if a doctor were to advocate 
going without food until serious weakness had set in. 

Let us take a case of serious febrile disease, pneumonia 
for example. If we know anything of the natural 
history of this disease, we know that its usual course 
is to go on until the vital forces are prostrated, and 
that the especial danger to be expected is from weakness 
of the heart, Is it, then, the wise course to employ no 
measures to guard against or to prevent this condition? 

Shaller, speaking of strychnine, says: "All schools of 
physicians use but one medicine to stimulate paralyzed 
nerves and to restore paralyzed muscles, and that medi- 
cine is strychnine. There is no other medicine but 
strychnine that can so effectually stimulate the vital 
functions and arouse nerve-force. If strychnine is a 
proper remedy to use to cure paralysis, it is also a 
proper remedy to use to prevent paralysis." The same 
or a similar argument may be advanced with reference 
to digitalin. Both these remedies many times are given 
in conditions of comparative health, and are considered 
the best tonics we possess for their respective purposes. 

Given, then, a fever which, if unchecked, is sure to 
produce the conditions calling for strychnine and digi- 



MATERIA MEDICA 55 

talin, it seems to me that it is the part of wisdom to use 
them in minimum doses before the danger is imminent, 
and thereby prevent in many instances the urgent de- 
mand otherwise evidenced later in the disease. 

In the treatment of fever, then, the remedies at our 
command will be utilized in the various conditions some- 
what as follows: 

In the early stages of fevers not of a sthenic type, give 
aconitine; if markedly sthenic, veratrine; if the fever 
is high, the pulse full and bounding, and the patient 
a vigorous adult, the defervescent compound ; if the con- 
ditions are asthenic, and the patient not vigorous, or in 
any case where there is reason to anticipate heart weak- 
ness, and always in old persons, the trinity granule. 
As the fever progresses, change from the one to the 
other as conditions may indicate. 

And remember, that you do not need to wait for the 
diagnosis of typhoid fever or scarlet-fever or pneumonia 
before beginning this, the essential, treatment of the 
febrile process. A definite diagnosis, as it shows addi- 
tional symptoms and conditions, will call for additional 
remedies; but the essential fever is the same in all and 
requires the same treatment. 

Two Valuable Expectorants 

Apomorphine and Emetine, as expectorants and 
emetics, each with special indications for its use. 

As an emetic, apomorphine is best given hypodermical- 
ly, in doses of 1-16 to 1-10 grain. As an expectorant, 
it is specially indicated where the sputum is thick, viscid, 
and tenacious, when it may be given every fifteen min- 
utes until relief or nausea. 

It is well to bear in mind that apomorphine gradually 
turns to a light-green color this gradually deepening to a 
dark green, this being hastened when it is exposed to 
the air. This discoloration may be prevented by the 



56 ACTIVE-PRINCIPLE THERAPEUTICS 

addition of a few drops of vinegar to the solution ; still, 
there is no evidence that the medicinal properties of the 
drug are at all affected. 

Emetine possesses to a certain extent the properties 
of ipecac, but is less irritating and causes less dis- 
turbance of the digestive tract. It is seldom used as an 
emetic. As an expectorant, it is indicated by deficient 
bronchial secretion, with tough and adherent sputum, 
and a dry, harsh cough. 

Emetine frequently is combined with apomorphine, 
and to these two may be added codeine, in similar 
dosage, more especially when there is an irritative 
cough. This makes one of the most effective and re- 
liable cough remedies of which I have knowledge, and 
it can be prepared in a few minutes at the bedside. 

A Group of Useful Laxatives 

Aloin, Calomel, and Podophyllin, to increase the se- 
cretions of the various portions of the intestinal tract. 
Standard granules: aloin, 1-12 grain and 1-6 grain; 
calomel (usually given in tablet form), 1-10 grain; 
podophyllin, 1-64, 1-12 and 1-6 grain. 

Saline Laxative, as a laxative and cathartic of al- 
most universal applicability. A granular effervescent 
preparation of sulphate of magnesium. An indispens- 
able aid in "cleaning out, cleaning up, and keeping 
clean" the intestinal canal. 

SalitMa, same as the above with the addition of one 
grain of lithium carbonate and 1-250 grain of colchicine 
to each 90 grains or full dose of the finished product. 
This is especially desirable in conditions showing the 
' ' uric acid diathesis, ' ' and wherever a diuretic action is 
desired. 

Anticoiistipation (Waugh) is another compound 
granule of great efficacy in all forms of chronic consti- 
pation. Formula : 



MATERIA MEDICA 57 

Aloin, gr. 1-25; strychnine sulphate, gr. 1-500; atro- 
pine sulphate, gr. 1-2500 ; capsicum oleoresin, gr. 1-500 ; 
emetoid, gr. 1-500 ; bilein, gr. 1-250. Should be given in 
sufficient number (three to six or more) three times a 
day before meals to produce one daily stool, continuing 
steadily and reducing very gradually as curative results 
are secured. 

Atropine, Hyoscy amine, and Hyoscine Hydrobromide, 
to combat spasm and to allay irritability. Standard 
granules: atropine, 1-500 grain and 1-250 grain; 
hyoscyamine sulphate, 1-1000 grain; hyoscine hydro- 
bromide, 1-1000 grain. All these belong to the mydri- 
atic group. 

Atropine is a cardiac and respiratory stimulant, re- 
laxing the minute capillaries and sending the blood to 
the surface. Hyoscyamine is mildly hypnotic and seda- 
tive. Hyoscine is more powerfully sedative and hypnot- 
ic, and is indicated in all motor excitation. 

Berberine and Quassin, as simple bitters of general 
applicability. Standard granules : berberine, 1-64 grain 
and 1-6 grain ; quassin, 1-64 grain. 

Berberine is the most, widely distributed bitter princi- 
ple in the plant-world. In addition to its valuable 
properties as a stomachic tonic, it possesses the property 
of constringing connective tissue, this rendering it of ex- 
ceptional value in all relaxed and catarrhal conditions of 
mucous membranes. Quassin is one of our best sto- 
machic tonics. 

Agaracin, grains 1-12 and 1-2, to arrest perspiration. 
Our best agent in night-sweats. 

Anemonin, grain 1-128, a camphor from anemone Pul- 
satilla, has a special action on the generative function in 
women, producing an increased menstrual flow when 
used near the menstrual period. 

Anodyne for Infants (Waugh) is used in the pain 



58 ACTIVE-PRINCIPLE THERAPEUTICS 

and restlessness due to indigestion, teething, and other 
causes. As a remedy in diseases of children, it has a 
wide range of uses, and is one of the most popular of 
the compound granules. The formula is: 

Nickel bromide, gr. 1-128 ; codeine sulphate, gr. 1-64 ; 
emetine hydrochloride gr. 1-5000 ; lithium carbonate, gr. 
1-16 ; oil of anise, q. s. 

Cactoid, a concentration from cactus grandinorus, as a 
valuable heart tonic. While of proven efficacy, cactus in 
medicinal dosage is without appreciable physiologic 
action, and for that reason condemned by so-called au- 
thorities. Cactoid is especially indicated in irregular 
pulse and nervous conditions of the heart. Standard 
granules, 1-128 grain and 1-64 grain. 

Caffeine, as an unequaled brain stimulant. It pro- 
motes the flow of thought and increases the mental activ- 
ities, without being followed to any considerable degree 
by depression. The salts (so called) of caffeine in vogue 
are the arsenate, benzoate, citrate, and valerate. Stand- 
ard granules of either : 1-64 grain and 1-6 grain. Very 
much larger doses may be given, though. The sudium 
benzoate is best adapted for hypodermic use, for which 
purpose the ordinary dose is 1 grain. 

Two Systemic Antiseptics 

Echinacea and Calcium Sulphide, as our best systemic 
antiseptics. Both drugs are of great value in averting 
and overcoming sepsis in its various forms. The stand- 
ard tablet of echinacea (echinacoid) is 1-2 grain; and the 
standard granule of calcium sulphide is 1-6 grain. 
Calcium sulphide, however, may be used freely in 1-2- 
and 1-grain doses. Nevertheless, Doctor Abbott claims, 
and experience amply has proven, that the granule form 
preserves the virtues of the sulphide far better than 
when made into tablets. Moreover, there is a vast dif- 



MATERIA MEDICA 59 

ference in the quality of the various preparations offered 
the doctors — some being utterly worthless. 

Arsenic, in its several forms, as the great alterative. 
The salts of arsenic commonly employed are the bromide, 
iodide, and sulphide. Standard granule of either, 1-64 
grain. 

Coniine (Cicutine) and Solanine, as antispasmodics 
and motor sedatives. Standard granules: coniine (cicu- 
tine) hydrobromide, 1-64 grain; solanine hydrochloride, 
1-64 grain and 1-6 grain. Solanine is especially valu- 
able in some cases of epilepsy. 

Codeine and Morpliine, as anodynes. Standard 
granules: codeine, 1-64, 1-12, and 1-6 grain; morphine 
hydrobromide, 1-64 grain ; morphine hydrochloride, 1-64 
grain, and 1-12 grain; morphine sulphate, 1-64, 1-12, 
and 1-4 grain. Codeine is especially valuable in irri- 
tative coughs. 

Copper Arsenite and Zinc Sulphocarbolate, as intes- 
tinal antiseptics and as antizymotics. Standard 
granules : copper arsenite, 1-1000 grain and 1-250 grain ; 
zinc sulphocarbolate 1-6 grain. Also, tablets of zinc 
sulphocarbolate ; 1, 2y 2 , and 5 grains. 

Ergotoid, Hydrastine, and Hydrastinine, to constringe 
unstriped muscle-fiber, as well as to quicken the heart. 
Standard soft mass pills of ergotoid, 1-6 grain. Stand- 
ard granules of hydrastine, 1-64 grain; of hydrastinine 
hydrochloride, 1-12 grain. 

Scutellaroid and Cypripedoid, concentrations of 
skullcap and lady 's-slip per, respectively, as mild seda- 
tives, anodynes and nervines. Standard granules: 
scutellaroid, 1-6 grain; cypripedoid, 1-6 grain. 

Iron, and its salts, to enrich the blood. Standard 
granules of the salts of iron, 1-64, 1-12, and 1-6 grain. 

Quinine, and its salts, to antidote malaria. Standard 
granules of quinine arsenate, which is the salt preferred 
by dosimetrists, 1-64 and 1-6 grain. Burggraeve claimed 



60 ACTIVE-PRINCIPLE THERAPEUTICS 

that quinine heightens the tonicity of the tissues; and 
this perhaps, may account for its action in preventing 
and aborting colds. 

Nuclein and Lecithin, to strengthen the defensive 
forces of the system. Dose of nuclein, 1-2 to 2 drops ; of 
lecithin, 1-2 grain. 

Glonoin, to relax the capillaries and quicken the heart. 
Standard granule, 1-250 grain. This remedy acts very 
quickly when given by the mouth — more so when ab- 
sorbed from the buccal cavity. 

Arbutin, to remedy all catarrhal and suppurative 
conditions of the mucous membrane of the genitourinary 
system. Standard granules: 1-64 grain and 1-6 grain. 
Tablet, 1 grain. In small doses arbutin is diuretic and 
tonic to the mucous membranes ; in medium doses, useful 
in subacute and chronic cystitis and to restrain the loss 
of albumin in nephritis and pus in pyelitis and other 
forms of pyelitis. In large doses, a stimulating diuretic, 
and strongly antiseptic. Useful in cystitis. 

Aspidospermine, to relieve dyspnea of every kind: — 
bronchial, cardiac or nervous. This alkaloid from que- 
bracho sometimes is called "the digitalis of the respira- 
tory organs." Standard granules, 1-6-1 grain. 

Bryonin, to stimulate absorption and relieve pleuritic 
pains. A remedy for serous membranes. Standard 
granule, 1-64 grain. 

CantJiaridin, to overcome atony of the bladder. Stand- 
ard granule, 1-5000 grain. 

Gelseminine, to combat febrile conditions, when asso- 
ciated with bright eyes, flushed face and great nervous 
tension. A remedy especially in diseases of children. 
Standard granule, 1-250 grain. 

Pilocarpine, to produce diaphoresis. The most power- 
ful agent for this purpose that we possess. Standard 
granule (of the nitrate) 1-64 grain. 

Potassium DicJiromatc acts as an alterative to mucous 



MATERIA MEDICA 61 

membranes, particularly of the respiratory tract. 
Standard granule, 1-64 grain. 

Sanguinarine acts as a general tonic and expectorant ; 
also is a sexual stimulant. Standard granule, 1-64 grain. 

Iodized Calcium (Calcidin), to combat membranous 
laryngitis (true croup), catarrhal laryngitis, and all 
forms of colds, especially those affecting the throat. 
Iodized calcium (Calcidin) also produces the systemic 
effects of iodine without giving rise to the phenomena 
of iodism. Standard tablets, 1-3, 1, 2% and 5 grains. 

Creosote, to serve as a respiratory antiseptic and an 
antituberculosis remedy. Standard granule, 1-64 grain. 

PJiytolaccoid acts as an alterative and absorbent in 
glandular enlargements. Standard granule, 1-6 grain. 

Salicin acts as a sexual sedative. Standard granule, 
1-6 grain. 

A Few Reflections 

It will be observed that in a considerable proportion 
of the remedies named only one single use, either a, gen- 
eral or a special one, is named for each drug. This is in 
accordance with the belief that it is advisable to select 
the most important action of any given drug or the ob- 
ject which it serves in a more direct and positive way 
than does any other drug, and to make this the keynote 
for that remedy. 

Thus, for instance, we have "quinine, to antidote 
malaria." Now, quinine serves many other purposes, 
some of them quite important; but not^one of the un- 
named applications compares in importance with this 
particular one, while in no other condition are the re- 
sults so superior to those which can be secured by means 
of any other known drug as in this common and serious 
condition of malaria. Then there is glonoin, "to relax 
the capillaries and quicken the heart." In the case of 
this drug the purpose named is practically its only use, 



62 ACTIVE-PRINCIPLE THERAPEUTICS 

but it fulfills that far better than any other known rem- 
edy, at least in an emergency. 

By adopting this plan, the principal use of a. drug 
is readily learned and quickly brought to mind when re- 
quired. Moreover, the other and minor uses will easily 
take their places as they are needed. Still other drugs 
are used practically for only one indication, and that 
a limited one. For example, agaricin is useful to pre- 
vent excessive perspiration (night-sweats) ; and this is 
the favorite, although there are other drugs for that 
condition. I am not aware that agaricin is prescribed 
for any other indication. 

It would seem, then, that the natural method of study- 
ing drugs is the best one. Find out first its most im- 
portant use, the purpose which it serves better than any 
other remedy. As other uses are developed, let them 
take their proper places. 

Sometimes, however, a more perfect knowledge les- 
sens, instead of increasing, the number of uses of a drug. 
Thus alcohol was formerly recommended for nearly 
every diseased condition known to man. It was thought 
to protect one from the cold of winter and from the 
heat of summer; it was used to strengthen the weak 
and to comfort the afflicted ; to increase the appetite and 
promote digestion; and to take the place of food and 
prevent the pangs of hunger; to relieve pain, assuage 
grief, overcome melancholy; to prevent heart failure, 
bring about reaction in shock, bridge over the crisis in 
fevers, destroy the germs of infectious disease. 

But of late years physicians have gone more closely 
into the physiologic action of alcohol, while they also 
have learned more of other substances to produce the 
various results formerly thought to be secured by this 
one; with the result that the internal remedial uses of 
alcohol are now practically limited, among up to date 
scientific physicians, to two — to dilate the capillaries 



MATERIA MEDICA 63 

and quicken the heart, in small doses, and to benumb the 
sense of pain and produce easy death, in larger ones. 
But even here the first-mentioned use is better met by 
nitroglycerin, and the second by morphine. We now 
have perhaps a dozen drugs, each of which takes the 
place of alcohol in some one of its uses, and does that 
work better ; no one of them, though, will accomplish all 
the results ascribed to alcohol. 

The Value of Experimentation 

As practitioners of medicine, after passing your ex- 
aminations, it will be your privilege, and, I believe, your 
duty as well, to be real students of the action of drugs. 
You should not only learn what the books have to tell 
you of these things, but you should try to enlarge to 
some extent the bounds of knowledge. To illustrate how 
you can do this. 

For the last ten years I have been studying experi- 
mentally the properties of a little-known drug, the ver- 
bena hastata. This is not a very important drug — it is 
not even entitled to be called a drug of the second class. 
Most of the uses which formerly were ascribed to it by 
the few -books mentioning it at all are better met by 
other remedies. But I learned, a dozen or more years 
ago, that someone had used this humble herb-^the blue 
vervain — with apparent success in certain cases of epi- 
lepsy. Now, epilepsy is a disease in the treatment of 
which a large number of remedies have been tried, but 
not one of them with any great satisfaction (even the 
bromjides often do more harm than good), and so it 
seemed to me that the claim was worth trying out. Just 
to what forms of this malady the herb was best adapted, 
no one seemed to know — and this, then, was the prob- 
lem which I set for myself to solve. 

I began to prescribe the verbena hastata for a woman 
who just then had been made distinctly worse after a 
course of the well-known "compound-bromide treat- 



64 ACTIVE-PRINCIPLE THERAPEUTICS 

ment." The result of my experiment was favora.ble — 
so favorable, indeed, that the patient has continued the 
use of the verbenin from that day to this, for the reason 
that, while it did not wholly cure her, it has enabled her 
to control the manifestations of the malady more fully 
than any other treatment she has ever tried, and that 
with absolutely no unpleasant by-effects. I then tried 
this remedy in the case of another patient, who had been 
somewhat improved under the bromide treatment, but 
desired to avoid the very unpleasant incidental effects of 
that drug. Here verbenin not only failed entirely, but 
made the patient distinctly worse. 

As a result, I adopted tentatively as my first indica- 
tion for giving verbenin: "when patients have been 
made worse rather than better by the bromides. ' ' That 
was a broad rule, but the experience in ten years of fur- 
ther trial of the remedy has confirmed it. Meanwhile I 
have continued my study of the action of the drug in 
similar cases, until I now have five indications by which 
to judge as to its applicability ; and further use will, no 
doubt, develop others, and perhaps modify some of these 
five. 

In the meantime I came upon another drug — solanum 
carolinense — of greater power, but very unlike in action, 
which I have found to fit in a large number of those 
cases in which the patients were not helped by verbe- 
noid; so that in these two drugs, verbena hastata and 
solanum carolinense, or their representatives, I have 
been able to benefit a large proportion of all the epi^ 
leptic patients who have come under my care. But, in 
all my use of these remedies, it has been my constant 
study to determine the special indications, or, if you 
please, the particular class of cases, for which each one 
was fitted. It is in this way, it seems to me, that every 
physician can and should do his part in broadening the 
common knowledge of our profession. 



CHAPTER V 

The Active-Principle Treatment of Pneumonia 

PERHAPS I can conclude what I have to say to you 
about active-principle therapeutics in no better 
way than in giving you a few practical illustrations of 
its application to everyday disease ; and in doing this, I 
am going to begin with that most common, serious and 
fatal of all our acute diseases, pneumonia. My reasons 
for this are, first, that I know of no disease which it is 
more important for you to be able to approach with 
confidence and handle with success; and, secondly, that 
the treatment which I shall describe has in this disease 
won its finest laurels. 

"Pneumonia is a self -limited disease and runs its 
course uninfluenced in any way by medicine. It can 
neither be aborted nor cut short by any known means 
at our command." Such is the dictum of Osier, who is 
perhaps the most widely known English-speaking med- 
ical teacher in the world; and through the influence of 
his great name it has obtained wide circulation and a 
very general acceptance. 

However, this idea is the emanation of the rankest 
drug-nihilism, pure theory from the prince of drug- 
nihilists. It reduces the doctor to the position of a very 
inferior grade of head nurse, whose duty it is to watch 
the patient's symptoms while he is dying and then to 
certify solemnly that there was no help for him. 

The active-principle doctor does not accept this dic- 
tum, does not believe this theory. He believes that it is 
his duty to do something in the sick-room. More than 
that, he believes that it is in his power, not only to les- 

Isen suffering, but to modify disease and to lengthen life. 
He is the kind of doctor whom I want to attend me when 
I am sick. I leave it for you to settle it for yourselves 
whether or not you agree with me. 



66 ACTIVE-PRINCIPLE THERAPEUTICS 

The way in which the theory of Osier works out in 
practice is well illustrated by a. story told by a well- 
known physician at a medical meeting in my home town, 
some years ago, when the members present were discuss- 
ing the different methods of treating pneumonia. 

A Personal Experience 

When this doctor was a senior medical student and 
was just entering upon the first day of his service as 
interne in a large hospital he was confronted by what 
he diagnosed as a severe case of pneumonia, and he 
naturally felt in a quandary as to what he should do for 
it. Not being able to settle the question to his own sat- 
isfaction, he waited with some impatience the coming of 
his instructor on his daily rounds. This worthy soon 
made his appearance and questioned our novice as to the 
nature of this patient's disease. The young interne re- 
plied that he thought it was a case of pneumonia, and 
he anxiously asked what he ought to do. 

"Hm-m-m," was all the learned professor vouch- 
safed, passing on to his next patient. 

Fearful that something was wrong, the interne fol- 
lowed after him and repeated his question. 

''Hm-m-m," again hummed the instructor, as he ap- 
peared to be wholly absorbed in the case at that moment 
before him. 

Seeing that it was impossible for him to get any sat- 
isfaction at this time, the young doctor waited until the 
professor had finished his rounds and was about to take 
his departure, when he screwed up his courage and ap- 
proached him once more, repeating the inquiry, what he 
should do for his pneumonia patient. 

"Y-y-young m-m-man," replied the professor, who 
was an inveterate stammerer, "it m-m-makes such a 
d-d-d-damned little d-d-difference what you d-d-d-do in 



TREATMENT OF PNEUMONIA G7 

these cases that I have d-d-d-decided to let you exp-p- 
periment for you-you-yourself . " 

' ' And, ' ' added the doctor as he told us the story, ' ' I 
have been experimenting ever since." 

If, now, young ladies and gentlemen, you can get 
some ideas that will enable you to approach your first 
case of pneumonia with something of a definite idea of 
what you want to do, and how it can be done, you will 
find that this frame of mind will give you a. great ad- 
vantage over that of the man who accepts the Oslerian 
doctrine that it makes no difference what you do. You 
will have confidence in yourself; and this will get you 
the confidence of your patient and his friends. These 
two combined will prove to be the fulcrum upon which 
you can rest your lever of active-principle medication 
and move the world. For to you, to cure your patient, 
is to move the world. 

In the treatment of pneumonia (or, for that matter, 
of any other disease), you have to consider three things: 
(1) the patient, because no two persons are alike in ap- 
pearance and constitution or in physical vigor and the 
power of resisting disease; (2) the disease, because the 
severity of a disease depends in part upon the intensity 
of the infection, and the same disease varies in its man- 
ifestations at different times and under different condi- 
tions; (3) the treatment, because no two persons re- 
quire exactly the same treatment, even when the symp- 
toms are practically the same; and, also because similar 
results often may be produced by different methods of 
treatment. 

Use the Best Obtainable Remedies 

And right here let me say that, while I am advocat- 
ing what we call the active-principle treatment of dis- 
ease, it is no part of my purpose to urge you to confine 
yourselves strictly to the use of the so-called active prin- 



68 ACTIVE-PRINCIPLE THERAPEUTICS 

ciples. What we want is, not so much active principles, 
as the best obtainable remedies. 

We advocate this treatment because we believe that 
in the main, not only the remedies used, but the manner 
in which they are employed, are such as will produce 
better results than any others with which we are ac- 
quainted. 

But we do not confine ourselves strictly to any one 
class of remedies, nor do I advise you to do so. We are 
practicing medicine, and our business is to cure our 
patients. If you can find any remedies that will pro- 
duce better results — any medicinal principles more po- 
tent for good — than those I have described, by all means 
use them. 

It is only in this spirit that we can have any prog- 
ress in medicine. You must mix your remedies — "with 
brains, ' ' as the great painter mixed his colors ; you must 
treat your patients with the aid of common sense and 
good judgment, remembering that "circumstances alter 
cases. ' ' 

The first essential for the most successful treatment 
of pneumonia is that the physician should be called 
early — before the case is fully developed or all the classic 
symptoms have made their appearance. Nor, under 
those circumstances, should he wait for the further de- 
velopment before beginning active measures of treat- 
ment. To wait until it is possible to make a positive 
diagnosis, is greatly to lessen your chances of success. 

Remember the teaching of Burggraeve, that the great 
end of dosimetric medicine is "the prevention of ana- 
tomic-pathologic lesions, for these, once established, are 
above the resources of art." Put this over against the 
dictum of Osier — and choose for yourselves. 

A positive diagnosis can be made only when the 
symptoms are typical or the disease is well advanced. 
The early chill is characteristic, but in twenty percent 



TREATMENT OF PNEUMONIA 69 

of the cases it does riot occur. Rapid respiration is com- 
mon; still, the variation in this respect is so great that 
it is not safe to rely upon it. The quick pulse is not 
found in every instance. Even high temperature is not 
always present, and its absence has come to be recognized 
as a distinctly unfavorable symptom. Many patients 
have little or no pain in the chest from first to last, and 
sometimes there is almost no cough, even the rusty spu- 
tum being absent in a considerable number, especially 
in the aged. The crepitant rale, when well marked and 
persistent, is considered almost pathognomonic, but this 
sign sometimes is absent. 

So, do not wait for the occurrence of all these classic 
symptoms, but, when you find enough to indicate con- 
gestion of the lungs with fever, go to work at once to 
prevent, if possible, that further progress of the disease 
which alone will render a positive diagnosis possible. 

If there is a feeling of oppression and tightness 
across the chest, with pain and difficulty of breathing, 
I know of no better remedy than a mustard poultice ap- 
plied to the affected part and allowed to remain until 
pain is relieved and the breathing easier, when it may 
be replaced by an antiphlogistine poultice or a cotton 
jacke + If there is no pain or difficulty of breathing, 
the antipnlogistine — or any other "clay poultice" — may 
be applied at first. Under these conditions, many physi- 
cians prefer not to make use of any external applica- 
tions whatever. 

In nearly all cases of pneumonia a thorough clearing 
out of the intestinal canal at the outset is desirable. In 
cases characterized by constipation, nausea, and a coat- 
ed tongue, you may give 1-6 grain each of calomel and 
podophyllin every half hour until a grain has been 
taken, and follow in two hours with a heaping 
tablespoonful of a laxative saline. Or, if the case comes 
into your hands at night, you may give a single dose of 



70 ACTIVE-PRINCIPLE THERAPEUTICS 

a suitable purgative, such as the ' ' triplex pill, ' ' com- 
posed of aloes, blue mass, and podophyllin; and in the 
morning follow with the usual dose of the saline laxa- 
tive. 

In either of these ways, or in various others, you will 
be pretty sure to secure thorough elimination, which is 
an important point. After this, the bowels should be 
kept clean, securing at least one free movement each 
day, and for this purpose the saline laxative is often 
sufficient. 

To Reduce High Temperature and Relieve Congestion 

We come next to measures for the reduction of the 
temperature and the relief of congestion, using for this 
purpose remedies acting through the vasomotor nervous 
system. The great active-principle vascular sedatives 
are aconitine and veratrine, either alone or combined 
with the tonic alkaloids strychnine and veratrine, as in 
the dosimetric trinity and the defervescent compound. 

In children, in delicate women, in the weak, the aged, 
the debilitated, and in all patients showing a tendency 
to asthenia, the preferred remedy is aconitine. So far 
a,s the pulse is concerned, the special indication for acon- 
itine is the small and frequent pulse. 

Veratrine, on the other hand, is the remedy of choice 
in strong and vigorous adults, and in all subjects show- 
ing symptoms of a markedly sthenic character. Its 
special indication is a. rapid, full, and bounding pulse. 
In the same case veratrine may be required at one stage 
of the fever, while aconitine is called for at another. 

Both these remedies are of the greatest utility in the 
early stages of fever, and as a rule neither one should be 
given in the later stages, or in any stage of cases marked 
by great debility and lack of vitality, except as guarded 
by one or both of the tonic alkaloids, strychnine and 
digitalin. Indeed, knowing that if the disease runs its 






TREATMENT OF PNEUMONIA 71 

course the greatest danger in pneumonia arises from the 
strain upon the heart, the alkaloidist deems it wise to 
guard against any weakness in this direction from the 
first, and therefore often prefers to use the dosimetric- 
trinity granule from the first in all severe and markedly 
asthenic cases, and the defervescent granule in sthenic 
cases. 

The standard granule of aconitine hydrobromide is 
1-800 of a grain, and of veratrine, 1-128 grain. These 
are the minimum adult doses, and are best given dis- 
solved in a teaspoonful of hot water. If the fever is 
103° F. or higher, this dose may be given every fifteen 
minutes for a few times, then every half hour until the 
fever begins to lessen, as shown by the tongue becoming 
moist, the pulse softer and slower, and the temperature 
lower. When this effect has been produced, the remedy 
may be given every hour as long as it is considered 
necessary to continue the effect. If the initial fever 
is below 102° F., give the dose only half -hourly from 
the first. 

These are general directions, to enable you to 
make a beginning. But always remember that there 
is no fixed or arbitrary dose or frequency of admin- 
istration, the only object being to produce tlie desired 
effect. Some patients are affected very easily, others 
only with great difficulty. Some people are very hard 
to sweat, but I have noticed that even in these cases 
the fever generally declines in about the usual time 
under the influence of these remedies. 

Strychnine and digitalin are tonic remedies and 
their use is well understood by medical men of all 
schools. Strychnine is the great nerve tonic, and is 
especially indicated where there is imperfect or en- 
feebled respiration or a condition of general relaxation 
of the whole system. Digitalin is the great cardiac tonic, 
strengthening the heart and slowing the pulse. When 



72 ACTIVE-PRINCIPLE THERAPEUTICS 

given alone in considerable doses, it may sometimes be 
objectionable on account of its tendency to increase the 
blood pressure, but when combined with aconitine and 
strychnine, as in the trinity granule, this effect is pre- 
vented. The standard granule of strychnine arsenate 
is 1-128 grain, and of digitalin, 1-64 grain; and these 
doses may be given with perfect safety in the same fre- 
quency as the aconitine and veratrine, when combined 
with these drugs. 

There is one other active principle which I have 
learned to use in those cases of pneumonia which are 
complicated with pleurisy, as shown by a sharp "catch- 
ing" pain in one or the other side when breathing. This 
is bryonin, a glucoside derived from bryonia alba, a rem- 
edy of which you probably know very little. It is a 
remedy for serous membranes, and is especially indi- 
cated in pneumonia when there is felt a sharp, cutting 
or stabbing pain in the side, made Worse by motion. 

I will mention one other remedy which I have used 
with much success in the treatment of pneumonia, and 
which I desire to recommend to your favorable attention, 
although I do not claim that active-principle therapy 
has any mortgage on it. 

General Antiseptic Treatment in Pneumonia 

If pneumonia is a germ disease, as is now universally 
accepted to be the case, then nothing can be more ap- 
propriate than an antiseptic treatment. For this pur- 
pose I know of no more effective agent than creosote, 
which is eliminated largely by the lungs, and is entitled 
to be termed a respiratory antiseptic. Sajous declares 
that creosote is as nearly a specific in pneumonia as is 
quinine in malaria, Beverley Robinson, of New York. 
was one of the first to advocate its use in lung disease. 
Van Zandt, of Texas, has been especially prominent in 
recommending its use in pneumonia. He has found it to 



TREATMENT OF PNEUMONIA 73 

abort a considerable proportion of cases, to modify fa- 
vorably the symptoms and shorten the course of a still 
larger proportion, and only in a small proportion to fail 
of influencing it in any way. 

Creosote carbonate is the preparation commonly 
used. Sajous gives it in 10- and 15-grain doses every 
two or three hours. Van Zandt gives two and one-half 
drams in twenty-four hours as an average adult dose, 
and divides this amount into either two or four doses. 
My own experience has been with the preparation known 
as thiocol. This is a made-in-Germany, patented prep- 
aration, chemically known as the guaiacol sulphonate of 
potassium. 

The main advantage which I find in this, over the 
cruder preparations of creosote, is the fact that it has 
very little taste, and may be given in any desired dose 
without disturbing the stomach. A great disadvantage 
is that it is still sold at the high price of patented prep- 
arations. I give it in 5-grain tablets, two tablets every 
four, three, or even two hours to an adult, and I have 
never had any bad symptoms. It is a valuable addition. 

Reasons for Failures in Practice 

With the treatment thus briefly outlined, it is pos- 
sible to abort a considerable proportion of cases. That 
this result cannot be secured in all cases, is due to one 
or more of the three following causes : 

1. Lack of vitality in the individual, so that the 
system does not react favorably to the medicine. 

2. Unusual intensity of the infection, such that the 
vital forces are overwhelmed by the first onset of the 
poison. 

3. Late beginning of the treatment or lack of thor- 
oughness in carrying it out. 

But even when the fever is not aborted, the course 
of the inflammation is almost always favorably modified. 



74 ACTIVE-PRINCIPLE THERAPEUTICS 

and it runs a shorter course than when left to nature, 
with fewer alarming symptoms and far less danger of 
failure of the vital forces than is seen when the coal-tar 
products and other depressing remedies are used. 

After the crisis is passed and the fever is gone, only 
a condition of weakness and depression remaining, it is 
better to omit the aconitine from the dosimetric trinity 
and to rely upon the tonic effects of strychnine and 
digitalin alone. 

You will observe that from the beginning we have 
guarded against danger from, weakness of the heart, 
using for that purpose the tonic remedies strychnine and 
digitalin. Add one other needed drug, and most of the 
cardiac dangers in pneumonia may be satisfactorily met. 

Glonoin, or nitroglycerin, is the great emergency 
remedy, relaxing the tense arterioles, and letting the 
blood go free when the heart is overburdened. With the 
active-principle therapist this drug takes the place of 
alcohol, in a very large degree, compared with which he 
finds it quicker in action, freer from danger, and more 
satisfactory in results. Instead of the usual dose of 
1-100 grain, he prefers the dose of 1-250 grain, in gran- 
ule, repeating this as may be needed to secure the de- 
sired result. This is one drug which is said to act more 
quickly when absorbed from the mouth than when in- 
jected subcutaneously. When properly used, it works 
wonders. 

Treatment of the Cough 

The cough of pneumonia seldom requires more than 
four drugs, and these are emetine, apomorphine, codeine, 
and calcium sulphide. Emetine is especially indicated 
by deficient secretion; apomorphine by a thick, viscid, 
and tenacious secretion; codeine by the cough of irrita- 
tion as distinguished from the cough of expectoration ; 
and calcium sulphide by a hoarse, harsh, hard cough, 



TREATMENT OF PNEUMONIA 75 

with putrid secretion. The dose of emetine and apo- 
morphine each is 1-64 grain, and that of codeine may be 
1-64 or 1-12 grain, according to the nature of the case. 
They may be given either separately or combined, in 
aqueous solution, every fifteen to sixty minutes, as in- 
dicated. 

I have come to depend upon this mixture, which I 
call the A-C-E mixture, for use at the bedside, to loosen 
a tight cough, to the exclusion of almost everything else. 
The calcium sulphide is especially useful in the cough 
of bronchopneumonia, measles, whooping-cough, and the 
like. It is best given in 1-6-grain granules every hour, 
and may be given without dissolving, care being taken 
to take a few swallows of water with each dose. 

I can only give you the outlines of the use of any of 
the remedies named. You must learn their more inti- 
mate uses from your own experience, by getting used to 
them. Then you will know Avhat they will do. 

You will see that my idea of a drug to be used in the 
treatment of disease is something like that of a friend 
whom you depend on for help and comfort in the work 
of life. You must get acquainted with your drugs be- 
fore you can use them to advantage, before you know 
what they will do, and how long they will last. If they 
are the real thing, the more intimate your acquaintance 
with them the better you will like them, and the more 
you will learn to depend upon them. If they are only 
shams, you will soon find it out, and the sooner you get 
clear of them the better. 

Drugs are like friends in another respect. It is bet- 
ter to have a few good ones, old friends that you know 
and can depend upon, than a host of new ones, passing 
acquaintances, "said to be good," "highly recom- 
mended, ' ' but not known to you from your own experi- 
ence. 

I have not spoken of the importance of fresh air and 



76 ACTIVE-PRINCIPLE THERAPEUTICS 

plenty of it, of bathing, good nursing, propeV nourish- 
ment, and many other things essential to the proper 
treatment of pneumonia, because their importance is 
recognized by all physicians, and their use is not con- 
fined to one school of medicine or system of practice. 
These things play an important part in determining is- 
sues of life and death. 

Now — to sum up : 

The active-principle treatment of pneumonia should 
begin early. Its first aim is to abort the disease. 

For the digestive tract: "Clean out, clean up, and 
keep clean." Calomel, podophyllin, and salines are the 
preferred laxatives. Give liquid nourishment. "Keep 
on the right side of the stomach at all hazards. ' ' 

For the pulmonary congestion : Counter-irritation 
by mustard ; depletion by antiphlogistine. 

For the fever and the heart: Aconitine and vera- 
trine ; strychnine and digitalin ; glonoin. 

For the cough : Apomorphine, codeine, emetine, cal- 
cium sulphide. 

For pain : If slight, counter-irritation, codeine, bry- 
onin; if severe, morphine hypodermically. 

Watch the patient. Dosage to effect. No alcohol. 

A Word in Conclusion 

In finishing this course of lectures, young gentlemen, 
let me say to you that the different diseases which we 
have considered have been selected only as illustrations 
of the methods of applying the therapeutics of the active 
principles. They are not necessarily the most common, 
or even the most important that could have been se- 
lected. They are simply those in which I have bad a 
fair share of experience, and for which 1 have somewhat 
definite ideas and methods of treatment to suggest. Lot 
me urge upon you, as yon go out to begin your work in 
caring for the sick, the importance of making use of the 



TREATMENT OF PNEUMONIA 77 

most definite, positive, and dependable means and meth- 
ods at your command. 

It is a far cry from the herb teas and powdered roots 
of our grandfathers to the potent chemicals and active 
principles which are at our own command today. 

The old therapeutics Avas a mass of undigested facts, 
mostly clinical, dealing with remedies uncertain in their 
action, and not to be depended on as to their results. 
The new consists of a compact body of knowledge, both 
clinical and physiologic, relating to drugs which are 
definite in their action, and whose effects are well ascer- 
tained and always to be relied upon. The old remedies 
were bulky and largely inert, the new are concentrated 
and always active. The old were unpleasant in appear- 
ance and nauseous to the taste, the new are attractive 
to the eye, and either- tasteless or may easily be admin- 
istered so as to conceal the taste. The old were danger- 
ous because of their unknown potency and massive dose, 
the new are absolutely safe because of their definite ef- 
fects and the ease with which their action can be con- 
trolled when administered by the intensive method of 
dosage. 

The form and concentration of the active principles 
enables the practitioner in the cities and larger towns 
to have with him at all times the more important rem- 
edies, and to be able to administer them at a moment's 
warning when needed in case of an emergency. 

Their importance to the physician practicing in the 
country, or who is distant from his base of supplies, is 
well expressed by Dr. Robert Gray, who is himself one 
of the most remarkable figures in the medical history 
of our day, and who has practiced medicine for most 
of the time since the close of our Civil War in one of 
the southern provinces of Mexico. He writes as follows : 

"I carry 156 active principles, weighing in all less 
than five pounds with case, the equivalent of which in 



78 ACTIVE-PRINCIPLE THERAPEUTICS 

galenic forms would load two mules. I am never am- 
bushed by the enemy, when suddenly confronted by 
some desperate emergency, no matter what the disease 
or the emergency may be. I have the antidote while 
time for medication yet remains, and do not have to send 
prescriptions to a distant drug store for uncertain rem- 
edies, a makeshift often fatal to an imperiled life. ' ' 



CHAPTER VI 

The Treatment of Typhoid Fever 

ASA FURTHER illustration of the application of 
**■ active-principle therapeutics, I shall speak to you 
today of the rational treatment of typhoid fever. But I 
do not wish you to understand that there is any recog- 
nized method of treating this or any other disease which 
is limited to the exclusive use of the active principles 
of plant-remedies. Rather, I desire to call your atten- 
tion once more to the fact that the use of the active 
principles in the treatment of disease does not, in itself, 
make a physician an active-principle therapist; but 
neither does the use of other remedies in addition pre- 
vent his being such. 

Indeed, as I have already told you more than once in 
substance, the active-principle therapeutist as a rule is 
not a secterian, or a faddist, or an extremist in any 
direction. He uses the active principles and conforms 
to the other fundamentals of the method in most cases, 
for the reason that he has become convinced that the 
best results can be secured in this manner. But, in any 
case where experience or observation or testimony has 
convinced him that the cure of the patient can best be 
brought about in some other manner, he unhesitatingly 
departs from the tenets of strict active-principle medi- 
cation and uses that which to him seems the best 
method. Not methods, but results are the things to be 
sought after. 

You will find that typhoid fever does not always pre- 
sent itself in the sick-room as it is pictured in the lec- 
ture-room or in the text-book. I once heard a physician 
say that, although he had been in practice for ten years, 
he never had seen but one typical case of any disease. 
By which he meant that he had seen but one case which 



80 ACTIVE-PRINCIPLE THERAPEUTICS 

corresponded closely with the descriptions given in the 
books. He had learned the lesson that, while the teacher 
must describe the type, just as the artist must make 
his sketch a composite picture, in actual life no one case 
corresponds exactly with the type, no one individual 
perfectly resembles the composite picture. 

The Importance of Accurate Diagnosis 

It is not within my province to dwell upon the diag- 
nosis of typhoid fever ; your professor of practical medi- 
cine no doubt has instructed you carefully in this re- 
spect. Very likely he has told you that, while sometimes 
the diagnosis is easy and can be made early in the dis- 
ease, it is difficult in others, and much valuable time 
may elapse before one is quite sure as to the real nature 
of the disease. 

This was true to a much greater degree when I began 
the practice of medicine than it is today, and, hence, 
the need of such instruction may no longer be felt. For. 
by the aid of the methods of modern laboratory diag- 
nosis, the number of uncertain cases is reduced to a 
minimum. Especially is this true if it is your fortune 
to practice in or near a large city, where you can avail 
yourselves of the advantages now uniformly found in 
large hospitals, you will be able to rely to a great extent 
upon these methods to aid you in diagnosis ; and your 
results will, without doubt, be far more accurate and 
satisfactory because of these aids. 

And, indeed, you will need to avail yourselves of the 
latest and best methods which science has placed at your 
command, in order that you may do your whole duty, 
meet successfully the sharp competition to which you 
will be subjected, and bring the largest possible pro- 
portion of your patients safely back to health. 

But, if, on the other hand, it should fall to your lot 



TREATMENT OF TYPHOID FEVER 81 

to find your work in a sparsely settled country, where 
you are out of easy reach of the helps of which I have 
spoken, do not be downcast or discouraged because of 
these things. There are no advantages without corre- 
sponding disadvantages. Always when one end of the 
seesaw board goes down the other end goes up. 

In the country, you will be farther away from help, 
and, thus, will be obliged to depend upon your own re- 
sources. But, in compensation, you will develop self- 
reliance, independence of action, and an all-around ver- 
satility that does not characterize the specialist or the 
laboratory physician. 

Therefore, I say, develop yourself according to your 
opportunities, and you will be able to meet the responsi- 
bilities of life as they come to you. And this means 
that you should gain a thorough understanding of the 
most improved methods of diagnosis as well as of thera- 
peutics, and that in the treatment of disease you should 
bring to your aid every means within your reach. 

The Old and the New Idea Contrasted 

Typhoid fever is a specific disease, and its cause is 
a specific germ, the typhoid bacillus. The symptoms 
really are due to the presence of the bacilli in the blood 
— what might be termed a bacillemia. This condition 
is found at a very early stage and is continued through- 
out the disease. The intestinal lesions are centralized 
in the Peyer glands, but also are found in various parts 
of the intestinal tract. The glands in question are the 
site of entrance of the germs, just as the glands of the 
throat are the site of entrance of the bacilli of diph- 
theria; in either case the principal lesions existing at 
the point of entrance. ' 

The fever is the most constant, as it is the most im- 
portant, of the constitutional symptoms, and is present 



82 ACTIVE-PRINCIPLE THERAPEUTICS 

in virtually all cases, making its appearance*" at an early 
stage, often as the first symptom attracting the atten- 
tion of the patient. Usually, however, the intestinal 
symptoms are early manifested, and these and the aci- 
demia precede, and they also cause, the fever in every 
instance. 

For the reasons named, remedies directed to the fever 
itself can not be relied upon to check it as long as the 
specific germs retain their activity. And, as the removal 
of the morbific cause is always more important than the 
treatment of the resulting symptoms, it is even more 
material that we should strike at the germ than to 
combat the fever. 

A friend of mine, who was graduated from Harvard 
the year after I was from the University of Vermont, 
took for the subject of his graduating thesis "Typhoid 
Fever;" and in discussing the treatment he wrote as 
follows — this sentiment, he tells us, embodying the sub- 
stance of the teachings he had received on this point : 
"The treatment of typhoid fever is devoted to one end. 
namely, to keep up the patient's strength till the disease 
has run its course. There is no drug which will lessen, 
cure or cut short the disease. ' ' 

This statement has a most familiar sound and calls 
to mind the similar words of Osier with respect to pneu- 
monia; raising, indeed, the question as to whether Osier 
took his ideas from Harvard or Harvard and Osier both 
drank from the same fount of knowledge. Undoubtedlv 
the statement quoted represents the consensus of medical 
opinion of a generation ago. As for my friend, I am 
glad to be able to tell you that he has entirely repudiated 
those ideas and now advocates and practices something 
quite opposite to those pessimistic notions. 

Expectant Versus Prompt Treatment 

Perhaps the worst result of these teachings was the 
state of mind they engendered, leading, as they did. the 



TREATMENT OF TYPHOID FEVER 83 

practitioner of that day to make no endeavor to do any- 
thing for a fever, except to watch and wait until the 
disease was fully developed; and then the symptoms 
were treated, and the symptoms only, since according 
to the prevailing theory nothing could be done for the 
disease itself, either to cut it short, to cure it or even 
to lessen its intensity. 

But, glory be! No such hopeless dogma hampers the 
action of the active-principle physician. The main de- 
sire of such a practitioner is, to get at the disease early — 
and the earlier the better. He does not even wait until 
the diagnosis is final and complete before beginning the 
treatment, but treats the symptoms as he finds them. It 
is true that he still has difficulty in getting his cases 
as early as could be desired, but, thanks to his persistent 
teachings in this respect, he certainly does get called to 
his patient much earlier than did the fathers. 

Right here I want to impress upon your minds this 
one point, namely, that the most important point, the 
one thing which more than any other characterizes the 
active-principle treatment of typhoid fever and of all 
other acute disease, is the early beginning of treatment. 
This is in strict accord with the principles laid down by 
Burggraeve, the founder of dosimetry, who declared that 
' ' dosimetric medicine rests essentially upon its power to 
jugulate those fevers in which all acute maladies have 
their inception." But only at their start can these 
maladies be aborted. Therefore, begin early. 

Now, I do not claim that all cases of typhoid fever 
can be aborted, or even most of them — in the stage in 
which they usually reach us. But I do believe in the 
abortability of fevers and other acute diseases ; and that 
not merely as an ideal to be aimed at, but as a fact 
which can be actually accomplished in a considerable 
proportion of cases. And when we cannot succeed in 
cutting short the disease by early treatment, we can at 



84 ACTIVE-PRINCIPLE THERAPEUTICS 

least favorably modify the symptoms, prevent dangerous 
complications, shorten the duration, and lessen the mor- 
tality. If I did not believe this much, I should not have 
the courage to undertake the practice of my profession. 

Great Promise in Bacterin Treatment 

The vaccine, or bacterin, treatment of typhoid fever 
is one which promises great results, and although there 
is not yet a universal agreement as to the degree of its 
efficiency, from all indications it seems probable that 
with the further development of the method its value 
will be increasingly recognized. 

As a preventive measure, its importance certainly is 
well established. Dr. George M. Gould declares that it 
renders an individual practically immune to typhoid 
fever for at least two years, is attended by no danger 
and by practically no inconvenience, and that exhaustive 
experimentation has proven it reliable. This is gen- 
erally accepted as true, and it follows that antityphoid 
vaccine should be used in all epidemics, and also by all 
persons who are likely to be exposed to infection, such 
as are travelers in countries where pure water can not 
be obtained, as also soldiers and sailors in general. 
Indeed, it is largely through the experience of these 
latter classes that its value has been established. As a 
means of treating the disease once it is established, the 
place of the vaccine is not so firmly fixed, but seems, 
with each year, to be increasingly recognized. It does 
not interfere with other medical treatment, and when 
properly used it seldom does harm. 

For these reasons it seems to me advisable, when the 
diagnosis of typhoid fever has been made, to admin- 
ister the proper dose of typho-bacterin, and repeat the 
same at proper intervals throughout the course of the 
disease; meanwhile continuing the usual medical treat- 



TREATMENT OF TYPHOID FEVER 85 

ment. And here again we see the importance of begin- 
ning early ; for all authorities are agreed that the earlier 
this measure is employed, the greater is the benefit likely 
to be derived from it. 

The Essentials of the Treatment 

The essential treatment which is relied on by the 
active-principle physician combines three elements : it 
is eliminative, antiseptic, and defervescent. 

1. The treatment is eliminative, in order that the 
decaying and septic material in the intestinal tract, and 
throughout the system, may be removed, so far as pos- 
sible. 

2. It is antiseptic, in order that the entire intestinal 
tract as also the system in general may be rendered a 
less fertile soil for the growth and development of the 
specific germs. 

Many sneers, without justification, have been thrown 
at the antiseptic treatment of typhoid fever, on the 
ground of the evident impossibility of securing abso- 
lute asepsis of the intestinal canal. But no friend of 
intestinal antisepsis, however ardent, has ever claimed 
that such a thing is possible. 

On the other hand, however, no one has ever shown 
that the digestive tract, if it is cleared out at the begin- 
ning of the disease, and kept reasonably clear of the 
products of decay, and in addition is saturated and kept 
saturated with a nonpoisonous antiseptic agent, fur- 
nishes as good a soil for the growth and development 
of the typhoid or any other pathogenic germ as when 
these conditions are reversed. And this is all that the 
most enthusiastic friend of intestinal antisepsis ever has 
claimed. 

3. It is defervescent, not only because the fever is 
a source of danger in itself, but because the rise of 



86 ACTIVE-PRINCIPLE THERAPEUTICS 

temperature is an indication of the severity of the infec- 
tion; and, if it can be kept at a reasonable point, the 
danger is greatly lessened. 

Remember that each case must be treated on its own 
merits. The patient himself must be treated as well as 
the disease, and no two are alike. The symptoms also 
must guide in the treatment, as showing where the most 
vulnerable points are to be found, which need the most 
urgent attention, and to which the greatest care must 
be given. 

There should be no such thing as a routine treatment ; 
still, there needs must be a general plan, but which must 
be modified as conditions may seem to demand. It is 
this general plan of treatment which I shall try to lay 
down, one which is adapted to the average case and can 
be modified as may be needed. But, like the doctor who 
had seen only one typical case, you also may never see 
but one — or not even one — case to which the treatment 
I shall describe may seem the best adapted. 

A General Plan of Treatment Outlined 

The first thing needed is thorough elimination — clean- 
ing out. If the patient is seen early, begin with a tablet 
containingl-6 grain of calomel, 1-6 grain of podophyllin 
and 1-12 grain of bilein. Give this every half hour for 
six doses. Two hours after the last dose has been taken 
give a full dose of a laxative saline. If needed repeat 
this every two hours until the bowels have been thor- 
oughly cleaned out, ending with loose watery discharges. 
If there has been a preliminary diarrhea, it will take 
less to produce this result than when there has been con 
stipation. But the clearing out is needed under either 
circumstance. As for the dose, the effect is what is 
needed. If much is required, give much; if little, give 
little. 



TREATMENT OF TYPHOID FEVER 87 

When this result has been thoroughly secured, it is 
time for the next step, which is, to secure intestinal 
asepsis to the greatest extent possible. Here the agents 
to be employed, and which experience has shown to be 
the most effective, the safest, and the most reliable, are 
the sulphocarbolates of zinc, calcium, and sodium. These 
salts may be given either singly or, as more often desir- 
able, the three combined. This remedy should be given 
in doses of from 10 to 30 grains every two to four hours, 
according to the severity of the attack. It is best given 
in solution, with a plenty of water. Or the tablet may 
be crushed or even given whole in some cases, but always 
with plenty of water to insure ready dissolution in the 
stomach. 

Shaller says in regard to this procedure: "Where 
the evacuations are frequent and foul, 5- to 10- grain 
doses of any of the three sulphocarbolates or of the com- 
bined intestinal antiseptics not only checks the offensive- 
ness of the stools, but lessens their number. As the pres- 
ence of the sulphocarbolates in the intestine checks and 
prevents fermentative action, the high temperature of 
typhoid fever begins to decline and can be kept down 
by the administration of these remedies throughout the 
disease. . . . Treated on the above plan, typhoid 
fever will be of shorter duration than usual. Instead 
or running three weeks or more, patients are frequently 
up and about within two weeks. If this treatment is 
begun very early, the probabilities are that very few 
cases can run their full three weeks' course. Calomel 
and the sulphocarbolates do certainly abort many cases 
of typhoid fever." 

Abbott writes: "Not all cases pursue an eminently 
satisfactory course under the antiseptic method ; but the 
severe forms become scarce, the abortive cases frequent, 
and the disease puts on a milder aspect. The sooner the 
antiseptic method is put in practice, the more decidedly 



88 ACTIVE-PRINCIPLE THERAPEUTICS 

will its good effects be manifested. If the case is not 
treated until ulceration has occurred or until the 
patient's condition is desperate, and the believer in anti- 
septics is then called on to demonstrate his miracles, 
failure is probable. The sulphocarbolates will usually 
prevent the dangerous conditions of the third week, but 
there are better remedies to promote the healing of 
ulcers, prevent perforation, and stop hemorrhage; also 
to combat pneumonia. But when they are given early 
in the attack, in the manner described, there is little to 
be apprehended in the way of complications and 
sequels. ' ' 

Here again (pardon me for harping so persistently 
on one string) let me call attention to the stress which is 
placed upon beginning treatment early. When this is 
done, the dreaded complications seldom occur, while the 
doctor will be credited with having had to deal with only 
a light case of typhoid fever, or perhaps no typhoid 
infection at all. However, your patient gets the benefit, 
after all. 

The laxative treatment should be repeated in full 
every few days, and a sufficient dose of saline laxative 
should be given every morning to secure one or two loose 
movements each day. 

Steps in Combating the Febrile Condition 

The next thing to be considered is the treatment of 
the fever. It should not be inferred, of course, that the 
institution of this treatment is to be delayed until the 
eliminatives and antiseptics have accomplished their 
work; rather, it sometimes is the first form of treat- 
ment to be undertaken, and, moreover, always to be 
begun early. Thus, the different forms of treatment are 
to be carried on together or the one or the other may 
have the precedence, according to the symptoms in each 
particular case. 



TREATMENT OF TYPHOID FEVER 89 

The principal drugs to be relied upon for this pur- 
pose are : aconitine, veratrine, digitalin, and strychnine. 
It is sometimes objected that the first two of these 
drugs are sedatives and depressants, while the last two 
are tonics and stimulants — the two classes seeming to 
be antagonistic in their effects. 

However, you will remember that in a previous lec- 
ture I explained the selective action of the cells through- 
out the system, whereby each cell selects from the gen- 
eral blood stream those things which are needed for its 
building up, and rejects those which are foreign to its 
needs; that, while this is true when only enough ma- 
terial for proper nourishment is absorbed, it neverthe- 
less is possible to overwhelm or poison the blood-cells by 
an overdose, which forces them to take up more than the 
proper amount ; that this rule holds with regard to medi- 
cines as well as to foods; and that in this way it is 
possible to use to the greatest advantage remedies of 
unlike and even to some extent opposing properties, pro- 
vided only minimum doses are employed. ' 

Fever and the Vasomotors 

Along with this, you will remember the theory of the 
relation of fever to the vasomotor nervous system, as 
explained by Doctor Waugh, which was explained in the 
same lecture as the foregoing. He tells us that ''acute 
inflammatory attacks begin with a disturbance of the 
circulatory equilibrium. The affected part fills up with 
blood, which distends the capillaries, whose walls, relax- 
ing under the increased pressure, afford an example of 
relative vasomotor paresis, being abnormally weak in 
proportion to the pressure to which they are subjected. 
But, as there is no reason to suppose that the actual 
quantity of blood in the body has been increased, this 
overplus of blood in the distended capillary area indi- 



90 ACTIVE-PRINCIPLE THERAPEUTICS 

cates that there is too little blood in some other part 
of the vascular system. In other words, the vasomotor 
paresis in the hyperemia area is exactly compensated 
by a vasomotor spasm in some other vascular area." 

Now, the normal equilibrium of the circulation in 
these cases may be restored in either or both of two ways : 
by increasing the tonicity of the dilated vessels or by 
causing those which are contracted and comparatively 
empty to relax and dilate, or by both acting together. 
But, this is just what we undertake to do in the treat- 
ment of fever by the methods that are adopted by the 
active-principle medicationists. Contraction in the 
dilated areas is secured by means of the vasomotor ten- 
sors, strychnine and digitalin ; and relaxation in the con- 
tracted areas is obtained by the vasomotor relaxants, 
aconitine and digitalin. By either of these means, but 
best by both carried on together, the restoration of cir- 
culatory equilibrium is secured — and this is the great 
object to be attained. 

The basic prescription for fever, therefore, would con- 
sist of aconitine and digitalin. Aconitine inhibits the 
rapid action of the heart, slows and regulates the pulse, 
lessens the vascular tension, and lowers the temperature. 
Digitalin also inhibits the action of the heart, which it 
slows and strengthens, meanwhile restoring vascular ten- 
sion where it is wanting. To these two agents, Burg- 
graeve added strychnine, which is the most powerful 
vital incitant we possess, energizing every organ ami 
function of the body, and especially combating that ten- 
dency to weakness and debility which is common to all 
febrile diseases and increases with each day of their 
continuance. This happy combination of drugs is 
known as the dosimetric trinity, and is especially adapted 
to the asthenic form and stages of fever. 

To the basic prescription of aconitine and digitalin, 
Abbott added vera trine, constituting what is known as 



TREATMENT OF TYPHOID FEVER 91 

the defervescent compound. This addition of veratrine 
increases the inhibitory power of the combination, slows 
the pulse, and opens every door of elimination, so that 
it is one of the most effective agents for the removal 
from the body of the various toxic products, whether 
of infectious agents, morbid metabolism or from absorp- 
tion from the alimentary canal. 

When Aconitine, When Veratine? 

As an agent in the treatment of fever, aconitine is 
the preferred remedy in children, in ephemeral fevers, 
and in the earliest stages of fevers in asthenic forms. 
Veratrine is the remedy of choice when the case is 
sthenic in its nature and the pulse full and bounding. 
But when the patient is debilitated, markedly asthenic 
or the disease is one which in its ordinary course leads 
to great weakness and debility, especially heart weak- 
ness, then the trinity granule of aconitine, digitalin, and 
strychnine is to be used from first to last. But in a 
disease like pneumonia, when it is desired to secure quick 
results and the patient is plethoric and full-blooded, 
then the defervescent granule is the thing. 

Furthermore, in the different stages of the disease, 
we often change from the one to the other combina- 
tion as the symptoms may change. Moreover, when it is 
especially important to reduce the fever quickly in a 
patient who has a good heart and is not debilitated, this 
result may be obtained by the use of the coal-tar pro- 
ducts acetanilid or acetphenetidin more quickly, 
although with greater danger and less permanently, than 
with the defervescent alkaloids. 

Remember that the doses of the tonic alkaloids, strych- 
nine and digitalin, are not such as to stimulate power- 
fully, not such as to serve as a whip to the tired horse, 
but rather such as to afford proper support and prevent 



92 ACTIVE-PRINCIPLE THERAPEUTICS 

exhaustion of the vital forces. Much can be done by the 
proper use of these remedies to prevent the more dan- 
gerous complications and sequels which under other cir- 
cumstances often make their appearance and sap the 
vitality of the patient. 

The trinity granule may be given with safety every 
hour as long as may be needed. The aim should be to 
keep the temperature below 102 degrees or as little above 
that figure as possible. And when the fever is gone, and 
the aconitine, therefore, no longer is needed, while sup- 
port for the heart and nervous system is still indicated, 
then drop the single granule, and substitute in its place 
the granules of strychnine and digitalin, every hour or 
two hours for as long as may be needed. 

I believe that this treatment, thus briefly outlined, is 
superior to any other with which I am acquainted for 
the essential fever process under whatever circum- 
stances occurring. Of course, other agents may be added 
as indicated, and other methods may, in rare instances, 
be preferred. It is, however, a method simple, easy of 
application, and satisfactory in result to a greater de- 
gree than any other I have ever made use of. 

We now have considered the medicinal treatment of 
typhoid fever under the four heads of bacterial vac- 
cines, eliminative treatment, antiseptic treatment, and 
antiphlogistic, or febrifuge, treatment. It remains to 
consider the general care of the patient. 

General Management of the Typhoid Patient 

From the onset of the illness, the patient should be 
confined to the bed, which when possible should be in a 
large, well-aired and pleasant room. No room in the 
house is too good for the sick-room. "Walking cases" 
of typhoid fever, so called, are proverbially dangerous; 
the danger arising largely from the exposure and undue 






TREATMENT OF TYPHOID FEVER 93 

exertion necessarily involved as well as from the lack of 
proper care in other respects. Strict cleanliness should 
be observed in all things. Disinfection of the room itself, 
the bed, bedding, and all the clothing, as well as of the 
discharges, should be scrupulously carried out. Many 
agents are used for this purpose, but perhaps no single 
one better meets the requirements in most instances 
than chloride of lime.- 

It is the practice of most physicians to restrict the 
patient to a liquid diet during the continuance of the 
fever. This may include milk, rice- and barley-water, 
fruit- juices, bovine, beef -juice, white of egg, malted 
milk, and so on. 

Baths should be administered both for cleanliness 
and for the comfort of the patient. They may be hot, 
cold or tepid, according to the judgment of the physi- 
cian or the desire of the patient. The use of cold baths 
to control the fever is highly recommended by good 
authorities, but as a matter of fact, they are better 
adapted to institutional work than to private practice, 
and have never been as much used in this country as 
in Germany. 

Aiding the Defense 

Nuclein may be used with advantage to strengthen the 
defensive forces of the system, and echinacea to aid in 
bringing about systemic asepsis. In the severer forms, 
and especially where treatment is begun late, baptisoid 
sometimes is a valuable remedy. The special indication 
for this drug is a brown or purplish discoloration of the 
tongue and mucous membrane of the mouth, with a con- 
gested face and deep-red tongue. Quinine arsenate some- 
times is desirable for its tonic effect. Caffeine acts as 
a valuable diuretic and brain and nerve stimulant. 
Codeine may be needed to quiet irritated nerves and 



94 ACTIVE-PRINCIPLE THERAPEUTICS 

induce sleep. In exceptional instances, morphine, hypo- 
dermically, may be required for the relief of severe pain. 
In the active-principle treatment of typhoid fever there 
is no place for alcohol. 

When ulceration has occurred and serious symptoms 
are present — usually about the third week — threatening 
perforation, oil of turpentine is the standard remedy. 
When this is given in 5-drop doses every two to four 
hours, in capsule or in an egg emulsion, it is a usual 
thing to see the tympanites quickly subside, the tongue 
become moist, and the stools assume a healthier char- 
acter. 

For hemorrhage, the best remedies are: ice to the 
abdomen, silver nitrate in small doses up to 1 grain in 
a day, and atropine hypodermically, in 1-100- to 1-50- 
grain doses and repeated so as to keep the blood at the 
surface. Emetine hydrochloride, in 1-2- to 2-3-grain 
doses, hypodermically, has recently been advised for the 
treatment of hemorrhage and deserves a careful trial. 

Perforation of the intestine is perhaps the most dan- 
gerous of all the complications and calls for the prompt 
opening of the abdomen and resection of the diseased 
portion of the intestine. But when the case is treated 
antiseptically from the start, perforation seldom will 
occur. The same is true of the various other serious 
complications. 

I feel that I ought to ask your forbearance for so 
constantly iterating and reiterating, with what must 
seem persistent and needless frequency, the laws of 
active-principle therapeutics — to which, you may think 
I have been paying more attention in this talk than I 
have to the treatment of typhoid fever. The reason is. 
that I am not teaching you the practice of medicine, 
for I know that you will get better instruction from 
your regular professors than I could give you if I were 
to attempt it. What I am endeavoring to do is, to im- 



TREATMENT OF TYPHOID FEVER 95 

press upon your minds, in a way to last for the rest of 
your lives, the more striking features of a method of 
therapeutics which is comparatively new to most of you 
and concerning which you look to me to tell you more 
than you will be likely to get from anyone else in your 
present studies. 

You will note that I have not attempted to discuss the 
use of bacterins in the treatment of typhoid fever; this 
is not because I lack faith in these agencies, nor is it be- 
cause the active-principle men do not employ them — for 
the exact contrary is true. In this little book I have lim- 
ited myself in the main to medicinal therapy, and this 
is my theme. The truth is, that Doctor Abbott and his 
associates are warm advocates of the prophylactic bac- 
terin, and believe that even in the treatment of devel- 
oped cases of typhoid fever the typhoid bacterin has dis- 
tinct though limited value. 

May I add that another alkaloid, emetine, has recently 
been used by Frazier and others for the treatment of 
typhoid fever with alleged good results ? It is too early 
to say, as yet, just how great its value is or what its 
limitations are. 



CHAPTER VII 

The Treatment of Acute Infections 

DRW. H. BURGESS, of Tennessee— the man who 
invented one thousand new uses for epsom salt — 
reduced all known diseases to five, which he named 
Retention, Invasion, Enervation, Trauma, and Poison. 
If you will look upon these as five original types with 
which all diseases may be compared, or as five great 
classes in one or another of which all known maladies 
may be placed, you will see that Burgess was a man 
who thought for himself, even though his ideas do not 
run in the beaten tracks. 

The acute infections, to which I shall call your atten- 
tion today, all belong to Burgess' second class. They 
are invasions. To use the Doctor's own words, " there 
is an enemy present, and this whole array of symptoms 
is an invasion." 

Under the general head of acute infections, it is cus- 
tomary to consider all of the eruptive fevers — such as 
measles, scarlet-fever, small-pox, chicken-pox — with 
diphtheria, influenza, whooping-cough, mumps, and 
others of a similar nature, most of which commonly are 
regarded as diseases of children, for the reason that, 
being of a highly contagious nature, most persons con- 
tract them before arriving at the years of adult life. 
To these may be added a formidable list of other dis- 
eases, including pneumonia, typhoid fever, erysipelas,. 
and meningitis, all of which are acute infections. But 
to make up the class in this way would be to include 
in it an unduly large proportion of all the diseases the 
physician is called upon to treat, consequently I shall 
limit the term acute infections to the diseases first 
named. 



98 ACTIVE-PRINCIPLE THERAPEUTICS 
A General Consideration 

Let us first consider them as a class and see wherein 
they resemble the type, which is a composite of the whole. 

In the first place, they are all acute diseases and, 
beginning with a greater or less degree of fever, require 
special treatment for the hypertherma; except in those 
light cases in which only care, watching, and proper 
restraint are needed for restoration to health. Reduc- 
tion of temperature is best accomplished by means of the 
defervescent alkaloids aconitine and veratrine, aided 
when necessary by the tonic remedies strychnine and 
digitalin, according to the general method already de- 
scribed by me in dealing with pneumonia and typhoid 
fever. To the remedies named, some others may be 
added under special conditions. Each remedy has its 
special indication, and the remedies and combinations 
selected are varied with all the changing conditions of 
the patient and phases of the disease. With this under- 
standing, it is safe to say that the treatment for * ' fever, ' ' 
once learned, is learned, in its general outlines, for all 
classes of patients and every named disease. 

In the second place, since these diseases are all in- 
vasions of the body by an enemy from without, they are 
all benefited by some form of eliminative treatment, 
whereby the enemy may be driven from the system — or, 
if not driven out, at least rendered unable to thrive and 
grow, because the resisting power of the body has been 
raised and the natural immunity of the system to dis- 
ease, which is reduced by fecal toxins and retained 
waste, has been increased. Hence, elimination is an 
essential step in the treatment. 

Here again, the general principles to be followed are 
substantially the same as those which were laid down 
under the head of eliminative treatment in typhoid 
fever. There is, however, a variety of other drugs and 



TREATMENT OF ACUTE INFECTIONS 99 

remedial measures that may be called in aid, among 
them, calomel, podophyllin, bilein — small doses, singly 
or combined — followed by the saline laxative; or, in 
some cases, the old-fashioned remedy castor-oil may be 
superior to any of the others. Of course, other appro- 
priate remedies may be called for, while sometimes a 
laxative enema is advisable. There is plenty of oppor- 
tunity for intelligent choice. But, whatever is given, 
give it in small doses to effect. The doctrine of clean 
out, clean up, and keep clean is strictly applicable in 
all invasions — that is, acute infections. 

All Are "Septic" Diseases 

In the third place, they are all septic diseases, due 
to some poison introduced into the body from without. 
These poisons are believed to be living germs, each one 
specific to the disease which it produces. In nearly all 
of these diseases, this germ has been discovered and its 
habits studied. In others, this has not yet been done, 
but in all probability soon will be. And, since it is 
impossible to eliminate the poison completely, an anti- 
septic is also needed, whereby the sepsis may be over- 
come and the germ destroyed ; or, when this is not prac- 
ticable, at least its vitality may be sapped and the soil 
in which it exists rendered infertile, so that its growth 
may be hindered or prevented. These results may 
usually be accomplished by means of chemical antisep- 
tics, employed both internally and externally. 

When taken into the system, these germicides in many 
cases show an affinity for some particular organ or tissue. 
Thus, calcium sulphide exerts its characteristic effects 
upon the blood ; the sulphocarbolates, upon the intestinal 
canal; creosote, upon the respiratory organs; hexa- 
methylenamine, upon the urinary organs; and so on 
through the list. Salvarsan acts specifically in syphilis ; 



100 ACTIVE-PRINCIPLE THERAPEUTICS 

quinine, in malaria; emetine, in dysentery. The par- 
ticular remedy to be employed will, therefore, be de- 
termined by the nature of the disease and the organs 
and tissues which are chiefly affected thereby. This 
form of therapeutics sometimes is referred to as chemo- 
therapy. 

In the fourth place, since they are all specific dis- 
eases and produced by definite living germs, each one 
propagating only its own kind, it follows as at least a 
probability that each one may be successfully treated 
with some form of serum, vaccine or bacterin admin- 
istration. As a matter of fact, this form of treatment 
has been developed and is being employed with success 
in some of the acute infections ; in others it is being de- 
veloped and is now on trial; while in still others the 
specific germ has not yet been isolated and no progress 
has been made at the therapeutic end of the problem, 
though even here it seems likely that the near future will 
see great progress in this direction. Thus, vaccination 
was first employed in smallpox, antitoxin has won its 
greatest laurels in diphtheria, bacterins are used with 
considerable success in typhoid fever, while in measles, 
up to the latest of my information, the microorganism 
had not yet been discovered. 

Four Different Methods of Treatment 

We find, then, four different methods of treatment 
that are common to most or all of the acute infections; 
these being: the defervescent treatment, the eliminative 
treatment, the antiseptic treatment, and the biologic 
treatment. And it seems to me that you can get a 
more practical knowledge of this subject, that you will 
be better prepared to treat these cases when you meet 
them in your practice, if you will familiarize yourselves 
with the general nature and specific applications of each 



TREATMENT OF ACUTE INFECTIONS 101 

of these different methods as well as the class of cases 
to which they are adapted, once for all, rather than to 
take rip the individual diseases separately and learn a 
separate treatment for each one. 

By this I do not mean to teach you that any two of 
these diseases are to be treated in the same way, or even 
that any two cases of the same disease are to be so 
treated; but only that there are certain general prin- 
ciples and conditions which are the same in each, and 
these may be learned once for all. 

You will be struck by the fact that these four forms 
of treatment are in general the same as those which I 
presented to you the other day in speaking of the treat- 
ment of typhoid fever. This arises from the fact, to 
which I have already alluded, that typhoid fever, strictly 
speaking, is a member of this class, an invasion, an 
acute infection. As a matter of convenience and because 
of its great importance, it has been considered by itself. 
But the general principles are the same as in the other 
members of the class. 

In addition to the four forms of treatment already 
referred to, it is necessary to make mention of at least 
one other, namely, symptomatic treatment. In this, as 
a sort of miscellaneous class, we may place all the meas- 
ures and remedies not already enumerated that are re- 
quired in the treatment of special symptoms, and which 
may or may not occur in any of the cases mentioned; 
which, though, when so occurring, are in the main not 
essential, but only incidental to the disease considered. 

Symptomatic Treatment 

An illustration of this is found in the use of morphine, 
which may be called for in almost any disease, at times, 
for the relief of severe pain ; but it is really no part of 
the treatment of the disease, being employed only for 
the relief of a symptom. Under this head, we use also 



102 ACTIVE-PRINCIPLE THERAPEUTICS 

heart and nerve stimulants and sedatives; remedies to 
aid digestion and improve nutrition; remedies that re- 
lieve local anemias and congestions, either by local or 
general action; and remedies that attack local foci of 
disease. 

We will now proceed to take up a few of the diseases 
individually, but only very briefly. My aim is not to 
exhaust the treatment, but only to suggest a few rem- 
edies for special diseases, and leave the rest to be treated 
according to the general principles which we have 
already considered. 

The Treatment of Measles 

Rubeola, or measles, is perhaps the most common and 
one of the most contagious of the eruptive fevers, few 
children escaping it. The symptoms and diagnosis are 
important, but it is not for me to dwell upon these. 
The first essential of treatment is, to begin early. The 
second is, to have full control of your patient and the 
family. Given these two things, and the responsibility 
is yours. Failing of these, the responsibility is divided, 
as is equally the probability of recovery. 

Treat the fever on general principles. Keep the 
bowels open and the intestinal canal reasonably aseptic. 
Saturate the patient with calcium sulphide. I shall give 
this last advice so often, it may be well to tell you just 
how to proceed. 

In the first place, you must remember that calcium 
sulphide is a somewhat unstable drug and that many 
of the preparations on the market are utterly without 
value, because of the fact that they have lost their 
strength. No preparation which does not reveal itself 
by the smell of sulphureted hydrogen soon after it has 
been ingested, is of any medicinal value whatever. So, 
when you are taking either the granules, pills or tablets 



TREATMENT OF ACUTE INFECTIONS 103 

of this substance, if you do not smell "rotten eggs" 
shortly afterward, your drug is of little value. As a 
matter of fact, judging from what information I can 
obtain, much of the calcium sulphide sold is of little 
value. This fact accounts for the widely differing opin- 
ions of different physicians concerning the value of this 
drug, some being enthusiasts in its favor, others declar- 
ing that they have never found it of the slightest value. 

The very first thing, then, is, to be sure you have a 
good drug. Some coated tablets keep their strength 
fairly well, but the granule seems to preserve its virtues 
better than other pharmaceutic forms. 

My own experience has been mostly with 1-grain tab- 
lets and 1-6-grain granules of proven reliability. Of 
these, the granules undoubtedly are to be preferred, and 
a 1-6-grain granule taken every hour will do more than 
a 1-grain tablet every four hours. Nevertheless, since 
many adult patients, especially if not seriously ill, will 
not take a small granule every hour, when they will take 
a large tablet every four hours, we sometimes must give 
the tablet or else order several granules at a single dose. 
But, whichever preparation is employed, be sure that 
it is active — that is to say, that it "smells the real 
thing." 

Whether or not the use of this remedy previous to ex- 
posure will render one immune to the disease, I am not 
prepared to say with any degree of certainty. I do 
believe, however, that such a saturation established 
either previous to exposure or during the stage of in- 
cubation would either prevent, abort or largely modify 
the symptoms of the disease; and I should use it with 
confidence for this purpose. 

In addition to this use as an antiseptic, the sulphide 
of calcium is also the best remedy for the cough of 
measles, which is hard, harsh, and hoarse. Indeed, for 
this kind of cough, no matter in what disease it occurs, 



104 ACTIVE-PRINCIPLE THERAPEUTICS 

there is. no better remedy than calcium, sulphide. Here 
the granules may be given every one or two hours or the 
tablets every two to four hours. 

At the same time you are prosecuting the germicidal 
treatment look out for elimination, by giving 1-10-grain 
calomel every half hour for ten doses, following this in 
an hour with the proper dose of saline laxative. If there 
is obstinate constipation or intestinal autointoxication, 
add to the calomel an equal quantity of podophyllin or 
else use the compound granule containing 1-6-grain each 
of calomel and podophyllin, giving six doses only. Re- 
peat the saline laxative, if necessary, in an hour or two, 
until free movements result. Or it may be advisable 
to give an enema. 

Meantime the child should be bathed in a carbolized 
solution of epsom salt, made by dissolving an ounce of 
the salt in a quart of hot water and adding 10 minims 
of carbolic acid. This is an excellent lotion to use for 
sponging the patient in all cases of the eruptive fevers, 
these bathings to be repeated once or twice daily through- 
out the course of the sickness. 

Aconitine may be prescribed for the fever, in the usual 
doses. That is to say, to 24 teaspoonfuls of hot water 
in a cup, add 1 granule for each year of the child's age 
and one additional granule. This is the general rule for 
active-principle dosage in the case of children, and is 
known as Shaller's rule. The frequency of the dosage 
is regulated by the height of the fever, the aim being to 
keep the temperature below 102 degrees. But, when 
elimination and antisepsis have been carefully attended 
to, in a large proportion of the cases the fever will be 
but slight and little, if any, treatment for it will be 
u coded. 

In the case of children, some practitioners prefer to 
substitute gelseminine for aconitine when there is present 
the special indication for the former remedy, namely. 



TREATMENT OF ACUTE INFECTIONS 105 

a flushed face, bright eyes, contracted pupils, and in- 
creased heat of the head. When this is prescribed, the 
same rules as to dosage prevail. 

Except in severe and long-continued cases, it is seldom 
necessary, when dealing with children in these diseases, 
to resort to the combination known as the trinity and the 
defervescent granules. 

When the eruption does not come out promptly, a 
hot bath, hot drinks, sponging with water containing 
mustard, or hot-packs on the chest will usually aid ma- 
terially in producing the desired result. This is im- 
portant, as there is always danger in the delayed erup- 
tion. 

The mouth, nostrils, and throat should be cleansed 
carefully with some alkaline antiseptic solution and the 
ears syringed with warm boric-acid solution once or 
twice a day. 

The bronchial symptoms may be largely controlled 
by means of inhalations, once in four hours, of a medi- 
cated vapor made by adding 20 drops each of oil of 
eucalyptus and oil of turpentine to a quart of boiling 
water. 

The diet should be light, consisting mainly of broths, 
gruels, fruit- juices, and the like. 

Special symptoms must be met as they arise. 

The Treatment of Scarlet Fever 

Here again the standard antiseptic is calcium sul- 
phide, and this should be given, not only to the patient, 
but to all exposed persons who have not had the disease. 
My own experience has convinced me of its great value. 
I will mention but one instance. 

A woman of thirty-five was taken down with scarlet- 
fever, which ran a fairly typical and moderately severe 
course. During her illness, the house was strictly quar- 



106 ACTIVE-PRINCIPLE THERAPEUTICS 

antined, and in it, besides herself, were confined her hus- 
band, her own little daughter of seven or eight years, 
and her husband's sister — none of whom ever had had 
the disease. 

From the very onset of the disease, I saturated all 
four persons with calcium sulphide, in the manner de- 
scribed under the head of measles. The smell of the 
sulphureted hydrogen gas was obvious in the breath of 
each one — and this is essential to securing the desired 
results. This treatment was continued until the patient 
recovered and the quarantine was removed. Neither of 
the exposed persons contracted the disease. This per- 
haps was not strange in the case of the adults, but that 
the child should escape certainly is suggestive. The three 
well persons in the house went freely in and out of the 
room where the sick woman was confined, no restraint 
being put upon them. 

I am aware that this one case proves little or nothing. 
Still, as one of a considerable number of similar cases 
occurring in my own practice and in that of my friends, 
it serves to confirm me in placing much reliance upon 
this drug as a preventive of scarlet-fever and to think 
that perhaps it acts the same in the other contagious 
fevers — though my experience with the latter has been 
less extensive in this respect. 

Another method of prophylaxis worthy of trial and 
likely to prove of value, although it has not as yet won 
general adoption, is the use of the scarlatina prophy- 
lactic bacterin. Further experience with this is desir- 
able. 

The treatment of the disease, when developed, is simi- 
lar in some respects to that of measles. Howovoi', here 
the temperature is higher and the general symptoms are 
more severe, while the local symptoms call for close 
attention. 

Carbolated epsom bath and general antiseptic treat- 



TREATMENT OF ACUTE INFECTIONS 107 

ment are of value here as in measles. The mouth and 
throat should be sprayed or gargled freely with a solu- 
tion of Seller's tablets, camphomenthol, borothyme, or 
some similar preparation, in proper dilution. Anoint- 
ing the entire body with cacao-butter or camphorated 
oil does much to relieve the extreme itching; also to 
lessen the contagiousness, if, as is generally taught, the 
contagious element is found in the scales which flake 
off the body. Intestinal antisepsis may be observed, with 
good results, from first to last. When desquamation is 
complete, the patient should take a hot bath in some 
antiseptic solution, then put on sterile clothing; while 
the rooms must be disinfected with formalin gas. 

The Treatment of Diphtheria 

Diphtheria is due to the Klebs-Loeffler bacillus, and 
this malady, previous to the discovery of antitoxin, was 
the most dreaded of all the acute infections. But now 
it has been largely shorn of its terrors, thanks to the 
antitoxin, and is now less to be feared than scarlatina 
or measles. 

You whose memory does not reach back beyond the 
days of antitoxin cannot realize the wonderful change 
which this remedy has brought about in the prognosis 
of this disease. For myself, I well remember my first 
experience with it, and the radical transformation it 
wrought in my own outlook. 

It was in the afternoon of December 27, 1895, when 
an Italian girl seven years of age was seen by a brother 
practitioner and, being found to have well-marked diph- 
theritic membrane in the throat, was duly reported to 
the board of health. As this physician was called away 
that night, he left the patient in my charge. When I 
saw the girl the next morning, I found her throat liter- 
ally filled and packed with diphtheritic membrane and 



108 ACTIVE-PRINCIPLE THERAPEUTICS 

realized at once that, situated as she was and good care- 
taking impossible, there was almost no chance for her 
recovery with the usual treatment. 

Antitoxin being a new remedy and much praised, I 
determined to try it ; but, the next day being a holiday, 
I had great difficulty in getting the antitoxin from 
Boston. However, I finally succeeded, and at 7 o'clock 
in the evening I injected 1000 units of the remedy; 
this being the dosage then prescribed. That was Thurs- 
day evening. On Sunday morning the child's throat 
was entirely free from false membrane and she was 
sitting up and writing on her slate. On the following 
Tuesday recovery was nearly complete and I paid my 
last visit. This result cannot seem as marvelous to you 
as it did to me at that time • for, you are used to seeing 
diphtheria treated in this way, and with similar results, 
while I at that time was not. 

The general experience with antitoxin therapy — and 
which should guide us — is that, if given on the first day 
of the disease, the mortality is almost nil, while for each 
day wasted the death rate is largely increased. Another 
score for the early beginning of treatment. 

Along with antitoxin, the usual antiseptic precautions 
should be scrupulously observed, not only as to the 
patient, but for the furniture, rooms, and all individuals. 
All exposed persons should be immunized by receiving 
a minimum dose of antitoxin. Use the concentrated 
antitoxin (globulin solutions) only. 

Internally, calcium sulphide, echinacea, nuclein, and 
calcidin are valuable remedies; and right here I 
want to add that while antitoxin is the specific remedy 
for diphtheria, there are many other useful remedies 
that should be used to meet special indications, some of 
which have just been mentioned. Of special importance 
is attention to the heart, which suffers severely. Watch 



TREATMENT OF ACUTE INFECTIONS 109 

it carefully, giving strychnine, digitalin, and other 
remedies as indicated. 

The principal source of infection is the diphtheria 
" carrier" — the individual who has had diphtheria (per- 
haps in such a light form that it was not properly 
diagnosed) and still harbors the Klebs-Loeffler bacillus 
in his throat. After clinical recovery be sure that the 
throat is free from this germ. If it lingers, clean it up 
by using sprays containing suspensions of the bacillus 
bulgaricus. The same local treatment is useful during 
the course of the disease; but, of course, no antiseptics 
should be used when these cultures are employed locally. 

In diphtheritic croup, intubation or tracheotomy some- 
times becomes necessary. My only fatal case of diph- 
theria treated with antitoxin was one of laryngeal croup. 
In cases of croup which is not membranous, calcidin 
proves successful in nearly all cases. 

The Treatment of Grip 

The grip, or influenza, is a disease of many forms and 
a great variety of symptoms. The violence of the dis- 
ease may fall upon almost any of the organs or systems 
of the body. The most common form is that in which the 
respiratory organs bear the brunt of the attack. Or, 
this may fall upon the digestive organs or upon the 
nervous system. Probably these three are the most com- 
mon forms. 

But when you have learned the grip from one angle — 
how it looks and how to deal with it — it is likely, in the 
next case to which you are called, to strike in a new way 
and at different organs; so that it is really a difficult 
matter to get on intimate terms with this protean 
monster. It is not a pleasant matter, either. And when 
there are so many forms and such varying symptoms 
it is not strange that the treatment varies greatly with 



1.10 ACTIVE-PRINCIPLE THERAPEUTICS 

different men and that there is as yet no general agree- 
ment. 

Nevertheless, in all its forms, there is one invariable 
characteristic of influenza, and that is the great depres- 
sion. If there is a weak spot in the system, the grip is 
sure to find it out and force an entrance at that spot. 
I might go a step further and say that, if there is no 
such weak spot when the grip attacks a man, there is 
sure to be such a one when it leaves him. Therefore, 
every form of treatment should aim at supporting the 
patient; the vital powers must be sustained in every 
possible way. Beyond this, the treatment is largely 
symptomatic. 

Alcohol, opium, and all narcotics are to be avoided, 
because of their secondary depressing effects. Also the 
coal-tar products are looked upon with suspicion by the 
best therapists. Strychnine and digitalin frequently 
will be found necessary. 

For the fever, I have no better plan to offer than the 
usual dosimetric method, with which by this time you 
ought to be getting somewhat familiar. Aconitine in the 
early stages perhaps, but more likely the trinity granule 
from the beginning. Always fortify the heart. Do not 
wait for the symptoms of depression to manifest them- 
selves, but anticipate them and think yourself fortunate 
if you are able to forestall them. 

Heat is a valuable adjunct to the treatment. The hot 
bath, hot-water-bags, hot drinks, hot capsicum-tea — all 
these are good. 

Rest in bed is essential while the extreme depression 
lasts; and this is true in all forms of the disease. 

Highly nutritious and easily digested food, such as 
turtle-soup, clam-broth, raw oysters, milk and eggs, fruit- 
juices, coffee, and the predigested foods, may be given 
in small quantities every two or three hours and pushed 
to the limit of the digestive capacity. 



TREATMENT OF ACUTE INFECTIONS 111 

In the respiratory form of the attack, it is well to 
syringe the ears and irrigate the nasal passages with 
the alkaline antiseptic solutions, and to spray the nose 
and throat with campho-menthol or a standard anti- 
septic oil. Cresoline, oil of eucalyptus, and similar sub- 
stances may be vaporized, to fill the room with antiseptic 
vapor. For internal use in this form of influenza, iodized 
calcium is an especially valuable remedy. 

Another peculiarity of grip is that it is liable to lead 
to all sorts of complications. One of the most common 
and dangerous of these is pneumonia — and the pneu- 
monias of influenza are mixed infections, and always 
dangerous. 

We are still lacking in the knowledge of any specific 
antiseptic. We cannot yet with confidence attack the 
bacillus of influenza, either with a chemical product or 
with a bacterial vaccine. These things will come, we 
confidently hope and expect ; but as yet the treatment is 
largely symptomatic. Grip is a tricky devil, and the 
best way to meet him is to be clothed in the armor of 
good health and be guarded by the best of care ; and, if 
attacked, to give support at every avenue. 

To recapitulate briefly: 

In an epidemic of grip or when exposed to conditions 
which favor its approach, 

1. Live simply, guarding your health on every hand ; 
especially, look out for colds, be careful of your diet, 
and spare your nerves. 

2. If attacked, eliminate poisons and tissue waste 
by means of the usual measures in those circumstances ; 
support the system by proper nourishment and tonic 
medication; treat symptoms as they occur; avoid ano- 
dynes and narcotics. 

3. Look out for complications. 

Much more might be said, both of this and the other 
diseases of this class, but the hour is up and I must 
postpone further discussion until the next time. 



CHAPTER VIII 

The Management of Chronic Maladies 

UP TO this time we have considered only the treat- 
ment of acute diseases. In these conditions the 
needs of the patient are urgent. The treatment must 
begin early, and be pushed to effect. In the words of 
Burggraeve: "To acute maladies we must oppose a 
sharp and active treatment; that is to say, the treat- 
ment must proceed as rapidly as the disease." 

It must be remembered that in these cases the result 
to be sought for is speedy recovery, the thing most to 
be feared being death. This afternoon, however, we 
are to consider the general principles that should be 
followed in the management of chronic maladies, where 
the progress of the disease is slower, and where improve- 
ment and comparative comfort of the patient often is 
the best that reasonably may be anticipated, and where 
death is not always the worst thing to be feared. 

Some chronic diseases are curable under proper man- 
agement, while others are incurable under any manage- 
ment or any form of treatment. You may ask me, "If 
a disease is acknowledged to be incurable, why treat 
it?" The point is well taken; the answer, however, is 
plain. 

Suppose you yourself have a well-marked valvular 
disease of the heart. You may be quite sure that your 
affection never will be cured, never can be cured; still, 
is that any reason why you should be abandoned by 
your physician and left to suffer the worst that nature 
can bring upon you? Certainly not! For, with proper 
care and such treatment as may be indicated, you can 
in all probability go on for twenty years or longer in 
comfort and good health, scarcely knowing that you 
have leaky valves, save as it is revealed to you by the 



114 ACTIVE-PRINCIPLE THERAPEUTICS 

stethoscope of the medical examiner; while without ap- 
propriate treatment life would soon become a burden 
and death a welcome relief. 

It is told of a noted divine that he once gave a very 
remarkable prescription for the attainment of long life. 
Listen, and take note of it, for there surely is something 
in it. This is how to attain long life: "Have an in- 
curable disease — and take care of it." 

I do not, indeed, advise that you should follow liter- 
ally this suggestion, especially the first part of it ; and, 
yet, I think that if you will read between the lines you 
will see that it is one of the best prescriptions for lon- 
gevity that ever was given. For you may have noticed 
that it is the bluff and hearty athlete, the man who seems 
always well and active, the bon vivant who enjoys his 
food and thinks he can eat anything, because he has a 
cast-iron stomach — it is this kind of a man who has a 
way of dropping off suddenly in time of stress or strain 
or of dying quite unexpectedly at an age not past middle 
life. 

On the other hand, the man who has found his limi- 
tations, and who found them early in life; who knows 
that he has disabilities and weaknesses, and where they 
are to be found — and who then guards his weak spots 
with zealous care — this is the man who lives to a re- 
spectable old age (though perhaps not to extreme old 
age) and who does his full share of the best work of the 
world. The reason is that he has learned to take care 
of himself. And so it is with many chronic maladies: 
if early recognized and properly cared for they are fully 
compatible with length of days, a useful life, and per- 
sonal enjoyment. These things are worth remembering 
when we are considering the management of chronic dis- 
eases. 

Another difference between acute and chronic ail- 
ments is that when a person is ill with an acute disease, 



JMANAGEMENT OF CHRONIC MALADIES 115 

if the tide is turned and recovery sets in he expects to 
be well in a short time, able to stop all medical treatment, 
forget all thought of taking care of himself, and drop 
back into his old habits of living. But many times the 
chronic patient must content himself with something less 
than this — must make up his mind to keep a close 
watch over himself all his life, and it may be take more 
or less medicine as long as he lives — that is, if he wants 
to live long or be of any use in the world or enjoy him- 
self while he lives. 

It must be remembered that there are many abnormal 
conditions which, while not classed as diseases but merely 
as "diatheses," yet, are the cause of great discomfort 
and much suffering and meanwhile prepare the way for 
serious and even fatal diseases. For example, there is 
the condition — alas, all too common — of chronic consti- 
pation, which results in autointoxication, arteriosclerosis, 
rheumatism, neuralgia, and unnumbered other forms of 
suffering. 

Chronic Constipation 

Chronic constipation has many causes, all of which 
may be included under the two heads of inherited ten- 
dencies and acquired habits. It can be avoided in most 
instances by correct habits, provided they are formed 
in early childhood; and even after it has become in a 
measure fixed much may be done to relieve and correct 
it by proper diet, hygiene, and remedial measures of 
various kinds. 

I do not know of any medicine which can be depended 
on to cure constipation. In fact, very few confirmed 
victims are ever really cured at all, although they may 
be greatly relieved. However, the combination that has 
given me more help than any other, and which comes 
nearer to being a cure for chronic constipation than any 



116 ACTIVE-PRINCIPLE THERAPEUTICS 

other combination of drugs of which I have any knowl- 
edge, is the little anticonstipation granule devised by 
Doctor Waugh. In this granule a number of drugs are 
combined with great skill for the purpose, and the fin- 
ished product possesses the unusual property of produc- 
ing the desired effect in gradually and constantly re- 
duced doses, until at last, when taken in strict accord 
with the directions which Doctor Waugh has given, the 
remedy can finally be dropped entirely; and, with proper 
care, the constipation will not return. 

That is to say, this is the way it works in favorable 
cases. However, in order to secure the result named, 
it is not enough merely to swallow a certain number of 
granules at a given time each day. Like the great 
painter's colors, the granules must be "mixed with 
brains." Burggraeve's directions again apply here: 
"To chronic maladies, we must oppose a deliberate 
method of treatment. That is to say, the treatment 
should proceed slowly, in proportion to the lengthened 
duration of the disease. ' ' Many cases of chronic consti- 
pation fail to be cured because of the too rapid with- 
drawal and too early discontinuance of the remedy. 

Acidemia 

Then there is the condition known as acidemia, which 
is closely related to the so-called uric-acid diathesis and 
the various manifestations of rheumatism. As among 
its early indications may be mentioned fermentation in 
the different portions of the alimentary canal, with 
eructation of gas, sour stomach, heartburn, and an un- 
duly acid urine. This latter is easily discovered by Har- 
rower's method. When this acidity is found greatly 
to exceed the normal, it may be corrected, either by the 
administration of alkalis, to neutralize the acid ; or by 
means of eliminatives designed to stimulate the glan- 



MANAGEMENT OF CHRONIC MALADIES 117 

dular organs to greater activity, whereby the acid de- 
posits may be removed from the system ; or by a combina- 
tion of both of the two methods, in conjunction with 
such a regulation of the diet and general habits as will 
prevent or at least lessen the liability to similar deposits 
in the future. 

One of the best remedies for this purpose is Sodoxy- 
lin, containing sodium bicarbonate and sulphocarbolate, 
colchicine, juglandoid, and xanthoxyloid, besides sodium 
chloride and aromatics. This is put up in the form of a 
coarse granular powder, is readily soluble in hot water, 
and is not unpleasant to the taste. The most reliable 
indication for the use of this combination, and one in 
which I have never known it to fail of being useful, is 
a high urinary acidity. The simplest way with which 
I am acquainted of determining this acidity is by means 
of Harrower 's sodium-hydroxide test. When the urinary 
acidity, as thus indicated, goes up, from the normal of 
from 30 to 40 degrees, as indicated by the acidimeter, 
to 60 or 80 degrees or more, as often happens, then you 
may safely prescribe this remedy, with the confident 
assurance that it will bring help and comfort to your 
patient, besides the reasonable probability of a cure; 
provided, of course, this remedy is properly used and 
continued for a sufficient length of time. 

The patients to whom I first administered this mixture 
were selected because they showed a high degree of 
acidity of the urine, and their perspiration was so acid 
that it would tarnish chains and rings and gold and 
silver watches, and the like. One was a case of arthritis 
deformans of long standing in an elderly woman, and 
the other, one of alimentary glycosuria in a young man. 
I prescribed calomel, podophyllin, and the bile salts to 
be taken at night, with a sufficient dose of a saline laxa- 
tive in the morning to insure free movements of the 
bowels. This treatment was attended by great benefit 



118 ACTIVE-PRINCIPLE THERAPEUTICS 

and improvement in each patient, but both were obliged 
to continue it almost uninterruptedly for two or three 
years in order to keep up this improvement. In due 
time, however, conditions so changed that the improve- 
ment became virtually permanent, and it only was neces- 
sary for them to resort to the remedies in the occasional 
relapses occurring from unfavorable circumstances or 
lack of proper care. Of course, the arthritis deformans 
of these persons is not cured, nor ever will be; but the 
patient has been made vastly more comfortable and ex- 
istence rendered more enjoyable by means of the remedy. 

Another remedy of a somewhat similar nature, espe- 
cially useful in chronic rheumatism, is calcalith, com- 
posed of calcium carbonate, lithium carbonate, and 
colchicine, with aromatics. My personal experi- 
ence with this combination has not been extensive, but it 
is considered a most effective remedy for many of the 
common manifestations of the uric-acid diathesis, such 
as lithemia, gout, lumbago, certain forms of eczema, 
and so on, in addition to the common forms of articular 
rheumatism. 

There is nothing secret in these combinations, 
and the physician may write his own prescriptions, 
adapting the drug and the dose to each particular case, 
if he pleases. There are decided advantages in this lat- 
ter method ; the only disadvantage occurring to me being 
that most physicians cannot write offhand, and many 
druggists cannot compound prescriptions that will pre- 
sent the desired remedies in a form compact, convenient, 
and pleasant for use as those which have been prepared 
in large quantities by skilled pharmacists. 

By the rational employment of these and other rem- 
edies of the class, much may be done for the abatement 
of acidemias. The indications are not difficult to de- 
termine, nor are the remedies unpleasant to take — an 
important matter in chronic conditions, where the treat- 



MANAGEMENT OF CHRONIC MALADIES 119 

ment must be long-continued. When in your practice 
you are confronted by conditions of this nature, you 
will find them worth trying ; and, if you try them faith- 
fully, making an intelligent application of the general 
principles which I have suggested and follow the special 
directions which you will find laid down in the books 
of active-principle practice, you may rest assured that 
you will accomplish much good for your patients. 

Tuberculosis 

Great headway has been made in recent years in the 
control and prevention of tuberculosis, and the present 
death rate is less than half as great as it was not longer 
than fifty years ago. 

According to the modern management of tuberculosis, 
as practiced in sanitariums throughout the country, the 
three great fundamentals of treatment are: (1) fresh 
air; (2) rest; (3) forced feeding. Remember — air, rest, 
food. 

However, even these commonplace agents require care 
and discretion in their employment, and much harm may 
be done by their injudicious application. Thus, even 
fresh air may be of the wrong temperature or humidity 
or in other properties, or it may be managed injuriously, 
as in the case of drafts when a patient is in a state of 
perspiration, or being cold air when he is heated. Many 
persons undoubtedly have taken cold and had their lives 
shortened by the routine but injudicious use of fresh 
air, without regard to other conditions. 

So even rest should not be absolute, save in extreme 
conditions, but it needs to be mixed with a proper but 
variable amount of exercise (plus "brains")- Forced 
feeding is far from being an unmixed blessing, and I 
believe it to be in many instances a very unsafe pro- 
ceeding, if not directly harmful. Not what is taken 



120 ACTIVE-PRINCIPLE THERAPEUTICS 

into the stomach, but what is digested and assimilated, 
is the measure of improvement. Each patient needs 
individual study, in order that the treatment may be 
adapted to his personal needs. 

I am one of those who still hold to the old-fashioned 
notion that there are various medicinal agents that will 
aid greatly in the treatment of tuberculosis. Measures 
for the improvement of digestion frequently are called 
for, and when rightly used are of great value. Espe- 
cially are they likely to be needed when forced feeding 
is the rule. Pepsin, pancreatin, papain, and the various 
compound digestants many times are called for. Nuclein 
and lecithin are of value in strengthening the defensive 
forces of the system and in building up the nervous 
system. Iodine in its various forms, but oftenest (as a 
matter of preference) in the form of iodized calcium, 
benefits in many cases. 

A remedy in which I personally have great confidence 
is creosote. I can say this the more freely and strongly, 
because this is a remedy which has never been monop- 
olized or even specially advocated by the active-prin- 
ciple medicationists. To my mind, creosote is to the 
respiratory organs what calcium sulphide is to the blood 
and tissues generally, the sulphocarbolates to the intes- 
tinal tract, hexamethylenamine to the urinary organs, 
and so forth. It is both an antiseptic and an expec- 
torant. It is of value in pneumonia in all its forms, in 
bronchitis, both acute and chronic, influenza, and tuber^ 
culosis. It loosens and lessens the cough, relieves irrita- 
tion and promotes resolution and healing. 

I have prescribed creosote in various forms, including 
plain creosote in pill and tablet, as carbonate of creosote 
(or creosotal), guaiacol, potassium sulphonate of guaia- 
col (or thiocol), and calcium creosote (or calcreose). 
Some of these are proprietary or patented preparations, 
and, hence, are open to boycott by the ethical purists. I 



MANAGEMENT OF CHRONIC MALADIES 121 

do not like patented preparations, and I do not like trade- 
names of drugs ; but, I can see that each of them has its 
advantages, and when I have found a remedy which 
benefits my patients, that fact alone outweighs all ques- 
tions of ethics with me. And when a remedy has once 
established its usefulness in certain definite conditions 
of disease I prefer the original, even though it be a 
proprietary. 

The use of creosote in tuberculosis is as old as the 
hills and is vouched for by a long line of our best thera- 
peutists, from Reichenbach in 1833 down to the present 
time. Potter says of it that "in pulmonary tuber- 
culosis, when well borne by the stomach and continued 
over a long period of time, it has probably proved more 
efficient than any other remedy. ' ' 

Sajous states that "creosote is a valuable remedy in 
the first and second stages of tuberculosis, excepting 
those cases in which asthenia is to any degree marked. ' ' 
Thompson says: "The creosote treatment of tubercu- 
losis is a curious revival, after more than sixty years, 
of the use of a drug which fell into disfavor after its 
original trial. It is, on the whole, the most satisfactory 
drug for tuberculosis. ' ' Bartholow writes : ' ' Internally, 
also, creosote and carbolic acid, especially the former, 
have been used with conspicuously good results in the 
treatment of the several forms of consumption, except 
phthisis florida." Even Osier, who is very nearly a 
therapeutic nihilist, agrees that it "is an old remedy, 
strongly recommended by Addison; and the reports of 
Jaccoud, Fraentzel, and many others, show that it has a 
positive value in the disease." 

I have had considerable experience in the use of thiocol 
( which is chemically the potassium sulphonate of guaia- 
col) , principally in the treatment of pneumonia and the 
other acute diseases of the respiratory organs ; and have 
come to think very highly of it. The special point in. 



122 ACTIVE-PRINCIPLE THERAPEUTICS 

which it excels the cruder preparations is that it is not 
unpleasant to take and that it will be borne by the 
stomach in any desired dosage without creating any dis- 
turbance. I do not claim that it has any virtues other 
than those of creosote or its active ingredient, guaiacol ; 
still, I consider it as one of the best, if not the best, of 
the preparations and derivatives of creosote. The only 
drawback to the use of thiocol is its high price (owing 
to the German patent, which must now be nearly ex- 
pired). 

As for calcium creosote, or calcreose, my experience 
with it has been much shorter and less extended. As 
to- this preparation, however, there undoubtedly is an ad- 
vantage derived from the calcium with which the creo- 
sote is combined. Clinical workers have seemingly dem- 
onstrated the theory that calcium starvation is a prime 
factor in the causation of tuberculosis. Lime-starved 
dogs fall easy victims to bovine tuberculosis, while the 
addition of calcium compounds to their diet cuts short 
the progress of the disease and they gain weight and are 
restored to health. (See Van Giesen and Lynah, Med- 
ical Record, Nov. 27, 1908, and July 1, 1909.) It is well 
known that calcium is essential to the formation of the 
fibrin element in the blood, and also that the healing of 
tuberculosis foci is largely a calcification process. In 
these facts I find the reason why calcium creosote acts 
so favorably in tuberculosis. 

My attention was called to calcium creosote not very 
long ago by a medical friend who himself is a victim of 
tuberculosis, having suffered from repeated hemorrhages, 
but who still continues to do a good general practice in 
one of our New England cities. This doctor assured me 
at that time that he did not think he would still be alive 
were it not for the benefit which he had derived from the 
use of calcium creosote. So strongly was I impressed 
by this remark, coming from a man in whose judgment 



MANAGEMENT OF CHRONIC MALADIES 123 

I had great confidence, that I at once began prescribing 
it for my own patients; and I have found it of great 
value. 

One other method of treatment for tuberculosis re- 
mains to be spoken of, one which has been strongly advo- 
cated and as strongly condemned. This is the vaccine, 
or bacterin, treatment; that is, the use of the various 
preparations and cultures of the bacillus tuberculosis. 
The pendulum has swung high and swung low in rela- 
tion to this much debated subject, from the days of Koch 
and his tuberculin, down to those of Friedman and his 
turtle-serum; and the question is still unsettled, with 
much difference of opinion yet existing. On the whole, 
however, it may be said that the advocates of the biologic 
therapy are steadily increasing; and it seems probable 
that, with future improvement in the preparation and 
technique, this method will be generally accepted as one 
of the most important aids to the medical treatment of 
tuberculosis. 

Epilepsy 

The last of the chronic diseases to which I shall call 
your attention is epilepsy. This is a chronic nervous dis- 
ease, characterized by recurrent general paroxysms ap- 
pearing at variable intervals, and attended by loss of 
consciousness and sensation. Its principal forms are the 
grand-mal, or major epilepsy; petit-mal, or minor epi- 
lepsy, and Jacksonian, or cortical, epilepsy. 

The theory of epilepsy generally accepted assumes the 
existence of a convulsion-center at the base of the brain, 
irritation of which will produce an epileptiform con- 
vulsion. The irritation may come from many different 
sources; but when once convulsions have been induced, 
no matter by what cause, they will be brought on more 
easily with each succeeding attack, until finally such 



124 ACTIVE-PRINCIPLE THERAPEUTICS 

changes have been wrought in the convulsion-center 
itself that thereafter the seizures occur at irregular in- 
tervals, without the intervention of any apparent cause. 

Epilepsy does not belong to the class of self-limited, 
or spontaneously curable diseases. Its natural course 
is from bad to worse, until a fatal result ensues, either 
as a direct result of the disease or, more likely, from the 
many complications following in its wake. It is esti- 
mated that not more than ten per cent of all victims are 
curable by any known method of treatment, while not 
more than fifty per cent are benefited in any appreciable 
degree even by prolonged treatment. 

You will see that these unfavorable statistics render 
the question of treatment of all the greater importance, 
and any plan of treatment which offers hope, even in 
selected cases, worthy of careful attention. 

In all cases of epilepsy, the first thing to be done is, 
to discover the primary source or cause of the irritation, 
and to remove or modify this as far as may be possible. 

The most frequent exciting causes are to be looked for 
in influences arising from one of three directions: the 
digestive organs, the sexual system, the mental func- 
tions. Look out carefully for all possible sources of irri- 
tation in each of these three directions. Time will not 
allow me to go into detail. 

If the cause can be determined, the next thing is, to 
remove it if possible, or, when this can not be done, to 
modify its effects or to render it comparatively inactive. 
In mild and incipient cases, no further measures may 
be needed to restore the patient to health ; and in a large 
proportion of cases there will be more or less marked 
improvement, either permanent or temporary. If no 
cause can be detected (and this is often the case), we arc 
accustomed to label such cases as idiopathic — although, 
strictly speaking, there probably are no idiopathic cases 
of epilepsy. 



MANAGEMENT OF CHRONIC MALADIES 125 

The second thing to be done is, to lead the patient 
into right habits of living, both as to diet and general 
hygiene. To do this, it is essential to secure the full 
cooperation of the patient himself. The food must be 
plain, simple, and easily digested, and the ordinary rules 
of hygiene as to diet must be scrupulously observed. 
Proteids should be allowed only in very limited amounts ; 
still, I do not believe that they should be prohibited 
entirely. 

The saltless diet is now very generally recommended 
for epileptics, but I have never seen any wholly satis- 
factory explanation of the benefits claimed for it. In- 
deed, in some patients it has been found that, while the 
paroxysms were measurably held in check by salt ex- 
clusion, yet, this was accompanied by a grave nervous 
condition, characterized by delirium and suicidal im- 
pulses, and all of which passed away when salt was 
restored to the diet. My own practice has been a com- 
promise between the two extremes. I direct that no salt 
be used as a condiment, but I do require that the food 
be prepared strictly without salt. This plan works satis- 
factorily for the patient, and saves much trouble for the 
family. 

Moderate exercise, both physical and mental, is de- 
sirable, but all severe labor of body or mind should be 
strictly prohibited. 

The third indication consists in providing proper med- 
ical treatment. This includes general and symptomatic 
medication, of which I shall not speak further, as it is 
conducted wholly on general principles and needs no 
special description. It also includes, in those patients 
having a distinct aura, provision for some quickly act- 
ing means of relaxing the vasomotor spasm, overcom- 
ing the muscular contraction, and thus preventing the 
occurrence of the convulsion ; the means to be employed 
at the first approach of the aura. The remedy most com- 



126 ACTIVE-PRINCIPLE THERAPEUTICS 

raonly employed for this purpose is the nitrite of amyl 
(preferably from perles, which may be carried in the 
pocket), this to be inhaled at the earliest indication of 
the oncoming of the paroxysm. 

However, the essential and important thing is, to over- 
come or to lessen the abnormal irritability of the con- 
vulsion-center. For this purpose, a multitude of drugs 
have been employed and are still being recommended. 
The one remedy which is almost universally used is the 
bromide of potassium or some other compound of bro- 
mine. But, while in some cases this is very beneficial 
in restraining the paroxysm, its secondary or incidental 
effects are unpleasant and injurious, producing depres- 
sion, dulness, and mental hebetude, with partial or com- 
plete loss of mental power ; while in a considerable pro- 
portion of cases no benefit is derived, the convulsions 
either not being affected or, not seldom, being made 
worse. 

Under these circumstances, a study of other remedies 
is essential, and I shall introduce to your attention two 
drugs which I believe to be far superior to the bromides, 
as has been proved by the experience of numerous phy- 
sicians during the past few years. These are, verbena 
hastata, commonly known as blue vervain ; and solanum 
carolinense, the common horse-nettle. 

Of verbena, I can speak from an experience extending 
over some twelve years or more. It is clearly a nerve 
tonic, and one of its earliest effects is in most cases to 
brighten up the mental powers of the patients and give 
them a more cheerful aspect. This is in marked contrast 
to the bromides. 

The class of cases in which I have found verbena to 
be especially beneficial includes, first, those in which the 
action of the bromides is distinctly unfavorable, render- 
ing the patient worse instead of better; and, secondly, 
the comparatively mild cases, in which the convulsions 



MANAGEMENT OP CHRONIC MALADIES 127 

are not extremely frequent or severe, nor are the mental 
faculties greatly impaired. This class includes most of 
the curable and a large portion of the improvable cases. 

As to the preparation used, all my experience has been 
with the concentration, known as verbenin or (of late) 
verbenoid. This is prepared in tablets of 1-3 grain each, 
representing about 15 grains of the crude drug. Begin- 
ning with one, two or three tablets at a dose, give this 
dose before each meal and at bedtime. Increase by one 
tablet each a day {not one at each dose), continuing until 
either the convulsions are measurably controlled or signs 
of ill or unpleasant effects from the drug become mani- 
fest. I carry this augmented dosage, without hesitation, 
up to as much as six tablets four times a day, and have 
never met with untoward effects. In one or two cases, 
I have observed another result; namely, that the patient 
was not improved by this course, but actually grew 
worse. This, of course, is an indication for dropping 
the drug. When this occurs, I change to solanum caro- 
linense. 

Solanum carolinense is a powerful antispasmodic and 
nerve sedative, and, unlike verbena, in large doses pro- 
duces potent physiological effects. The general indica- 
tions for its use I find in those cases where the bromides 
exert a beneficial effect on the convulsions (although at 
the same time producing secondary unpleasant effects) ; 
and, further, in all cases which resist the comparatively 
mild action of verbenoid. Theoretically, solanum should 
be of more value than the former remedy; but in prac- 
tice I have found it far less frequently applicable; or 
perhaps I should say, I have found it to be distinctly 
helpful in far fewer cases than verbena. 

I have given this drug in two forms; namely, the 
"specific medicine" of the Eclectics, and the more 
exact alkaloid, solanine hydrochloride. The dose 
of the "specific medicine" varies from 5 to 30 or more 



128 i ACTIVE-PRINCIPLE THERAPEUTK !S 

drops, to be taken before meals and at bedtime. The 
alkaloid is prepared in granules of 1-64 grain, and the 
dose of these ranges from three to eight or more, taken 
four times a day. The rule of dosage is the same as for 
the other active principles: begin with the minimum 
dosage and increase until the desired effect is produced. 

I have given only the briefest outline of the treat- 
ment which I recommend. Should any of you desire 
more complete details, I shall be pleased to send you 
reprints containing a fuller discussion and more definite 
instructions. 

In closing, let me say, Remember that epilepsy seldom 
is cured. Do not expect too much. When you have 
found a remedy which exercises a reasonable degree of 
control over the convulsive attacks, do not forget that it 
should be continued indefinitely, varied as to dose accord- 
ing to the needs of the case. Never pronounce a patient 
cured until at least two years have passed without any 
return of the paroxysms. 



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